Direct MALDI-TOF MS-based method for rapid identification of microorganisms and antibiotic susceptibility testing in urine specimens
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Abstract
Background and Objectives: Urinary tract infections (UTIs) are considered as a major public health issue, often causing complications. Although the traditional cultivation approach is reliable in diagnosis, it is time-consuming, leading to delay in treatment and contributing to antibiotic resistance due to suboptimal empirical treatments. This study aimed to evaluate the performance of a direct, rapid identification technique using MALDI-TOF MS for pathogen identification and antibiotic susceptibility testing in UTIs, aiming to reduce diagnostic time compared to standard culture methods.
Materials and Methods: In the span of a year, 458 monomicrobial urine samples were analysed using both the standard bacterial culture method and the direct MALDI-TOF MS-based method. Antibiotic susceptibility was directly tested on 20 samples using the disk diffusion method.
Results: The direct identification technique accurately identified 92.14% of microorganisms at the genus level and 60.92% at the species level within an hour, significantly faster than the 24 to 48 hours required by traditional culture methods. The direct antibiotic susceptibility test results were consistent with the standard post-culture method ranging from 60.00% to 100%.
Conclusion: Direct identification using MALDI-TOF MS can improve UTI management by enabling faster pathogen identification and targeted treatments, potentially reducing antibiotic resistance. Further studies are needed in terms of enhancing its clinical utility and reliability.
2. Franco AV. Recurrent urinary tract infections. Best Pract Res Clin Obstet Gynaecol 2005; 19: 861-873.
3. Kaye KS, Gupta V, Mulgirigama A, Joshi AV, Scangarella-Oman NE, Yu K, et al. Antimicrobial resistance trends in urine Escherichia coli isolates from adult and adolescent females in the united states from 2011 to 2019: Rising ESBL strains and impact on patient management. Clin Infect Dis 2021; 73: 1992-1999.
4. Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 1966; 45: 493-496.
5. Gupta K, Hooton TM, Stamm WE. Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infections. Ann Intern Med 2001; 135: 41-50.
6. Clark AE, Kaleta EJ, Arora A, Wolk DM. Matrix-Assisted laser desorption ionization-time of flight mass spectrometry: A fundamental shift in the routine practice of clinical microbiology. Clin Microbiol Rev 2013; 26: 547-603.
7. Haider A, Ringer M, Kotroczó Z, Mohácsi-Farkas C, Kocsis T. The current level of MALDI-TOF MS applications in the detection of microorganisms: A short review of benefits and limitations. Microbiol Res 2023; 14: 80-90.
8. Sundqvist M, Olafsson J, Matuschek E. EUCAST breakpoints can be used to interpret direct susceptibility testing of Enterobacteriaceae from urine samples. APMIS 2015; 123: 152-155.
9. Okada H, Sakai Y, Miyazaki S, Arakawa S, Hamaguchi Y, Kamidono S. Detection of significant bacteriuria by automated urinalysis using flow cytometry. J Clin Microbiol 2000; 38: 2870-2872.
10. Dekker JP, Branda JA. MALDI-TOF Mass spectrometry in the clinical Microbiology laboratory. Clin Microbiol Newsl 2011; 33: 87-93.
11. Hombach M, Böttger EC, Roos M. The critical influence of the intermediate category on interpretation errors in revised EUCAST and CLSI antimicrobial susceptibility testing guidelines. Clin Microbiol Infect 2013; 19: E59-E71.
12. French K, Evans J, Tanner H, Gossain S, Hussain A. The clinical impact of Rapid, direct MALDI-ToF Identification of bacteria from positive blood cultures. PLoS One 2016; 11(12): e0169332.
13. Degand N, Ruimy R. Intérêts et les limites actuelles du MALDI-TOF en microbiologie clinique. Interests and current limits of MALDI-TOF in clinical bacteriology. J Anti Infect 2012; 14: 159-167.
14. Rychert J. Benefits and Limitations of MALDI-TOF mass spectrometry for the identification of Microorganisms. J Infect 2019; 2: 1-5.
15. Jover-García J, López-Millán C, Gil-Tomás JJ, Callejón-Fernández M, Lecuona-Fernández M. Identification and antibiogram of Enterobacterales from direct urine samples using matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS) technology and disk-plate diffusion technique. Indian J Med Microbiol 2023; 46: 100457.
16. Li W, Sun E, Wang Y, Pan H, Zhang Y, Li Y, et al. Rapid identification and antimicrobial susceptibility testing for urinary tract pathogens by direct analysis of urine samples using a MALDI-TOF MS-Based combined protocol. Front Microbiol 2019; 10: 1182.
17. Ferreira L, Sánchez-Juanes F, González-Ávila M, Cembrero-Fuciños D, Herrero-Hernández A, González-Buitrago JM, et al. Direct identification of urinary tract pathogens from urine samples by Matrix-Assisted laser desorption Ionization-Time of flight mass spectrometry. J Clin Microbiol 2010; 48: 2110-2115.
18. İlki AA, Özsoy S, Gelmez G, Aksu B, Söyletir G. An alternative for urine cultures: Direct identification of uropathogens from urine by MALDI-TOF MS. Acta Microbiol Immunol Hung 2020; 67: 193-197.
19. Sánchez-Juanes F, Siller Ruiz M, Moreno Obregón F, Criado González M, Hernández Egido S, de Frutos Serna M, et al. Pretreatment of urine samples with SDS improves direct identification of urinary tract pathogens with matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol 2014; 52: 335-338.
20. DeMarco ML, Burnham CA. Diafiltration MALDI-TOF mass spectrometry method for Culture-Independent detection and identification of pathogens directly from urine specimens. Am J Clin Pathol 2014; 141: 204-212.
| Files | ||
| Issue | Vol 17 No 1 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v17i1.17805 | |
| Keywords | ||
| Matrix-assisted laser desorption-ionization; Urine; Bacteria; Urinary tract infection; Antibiogram | ||
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