2146. MALDI-TOF Mass Spectrometry Rapid Pathogen Identification and Outcomes of Patients with Bloodstream Infection: A Systematic Review and Meta-analysis

Abstract

BackgroundSeveral studies showed inconsistent results on the efficiency measures of the matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) technology and patients’ clinical outcomes. A meta-analysis was conducted to determine the effectiveness of MALDI-TOF MS-based bacteriology in improving the accuracy of microbiology report and clinical outcomes.MethodsPubMed and EMBASE databases were searched from database inception through May 1, 2018 for pre–post and parallel comparative studies that evaluated the use of MALDI-TOF MS for identification of microorganism from blood culture. Pooled effect estimates were derived using the random-effects model. Univariate meta-regression on trial-level covariates was used to assess heterogeneity sources. Funnel plot, Begg’s and Egger’s tests were used to assess publication bias.ResultsThirteen studies with 3,534 patients were meta-analyzed. Compared with conventional methods, MALDI-TOF MS was associated with 34% reduction in mortality (RR = 0.66; 95% CI: 0.54; 0.81; I2 = 27.6%; 9 studies); 5.3-hour reduction in time-to-effective antibiotic therapy (95% CI: -6.4; -4.3; I2 = 98.0%), 24.5-hour reduction in time to identify bacteria (95% CI: −25.7; −23.3; I2 = 91.0%); 0.9-day reduction in hospital stay (95% CI: −1.4; −0.3; I2 = 56.6%), and US$4100 saving in direct hospitalization cost (95% CI: $−8,200; $−113; I2 = 66.1%). No significant heterogeneity sources were found (all P-interaction from meta-regression > 0.05) and no statistical evidence for publication bias was found (all P > 0.05).ConclusionRapid pathogen identification by MALDI-TOF MS with or without antibiotic stewardship was associated with reduced mortality, improved outcomes of bloodstream infection, and may be cost-effective among patients with bloodstream infection. Nevertheless, a multicenter randomized controlled trial is needed to confirm findings of these pre–post comparison studies. Disclosures All authors: No reported disclosures.