Rapid detection of high-risk Enterococcus faecium clones by matrix-assisted laser desorption ionization time-of-flight mass spectrometry.

We aimed to explore the potential of matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) for early identification of dominant Enterococcus faecium (Efm) clones involved in human infections. Well-characterized Efm isolates (n=77), analyzed by pulsed-field gel electrophoresis and multilocus sequence typing(eBURST and BAPS [Bayesian analysis of population structure] algorithms), and belonging to different hospital (n=53) and community (n=24) phylogenomic groups, were tested. Mass spectra (Bruker) were analyzed by visual inspection and different chemometric tools. Discrimination between groups comprising isolates commonly found in hospitals (BAPS 2.1a, 3.3a1, 3.3a2) and community (BAPS 2.1b and 3.2) was achieved with >99% accuracy, while identification of sequence types belonging to different BAPS subgroups was associated with >95% correct predictions. Our work is a proof of concept with regard to the suitability of MALDI-TOF MS in the identification of high-risk Efm clones. Further studies including strains from a wider variety of clones and sources will strengthen the potential of the workflow here described.