Abstract
Several MALDI-TOF MS-based methods have been proposed for rapid detection of antimicrobial resistance. The most widely studied methods include assessment of β-lactamase activity by visualizing the hydrolysis of the β-lactam ring, detection of biomarkers responsible for or correlated with drug-resistance/non-susceptibility, and the comparison of proteomic profiles of bacteria incubated with or without antimicrobial drugs. Antimicrobial-resistance to a number of antibiotics belonging to different classes has been successfully tested by MALDI-TOF MS in a variety of clinically relevant bacterial species including members of Enterobacteriaceae family, non-fermenting Gram-negative bacteria, Gram-positive cocci, anaerobic bacteria and mycobacteria, opening this field to further clinically important developments. Early detection of drug-resistance by MALDI-TOF MS can be particularly helpful for clinicians to streamline the antibiotic therapy for a better outcome of patients with systemic infection, in all cases where a prompt and effective antibiotic treatment is essential to preserve organ function and/or patient survival.
Highlights
The application of MALDI-TOF MS technology to clinical diagnostic microbiology has provided a new, accurate and robust tool allowing rapid and reliable microbial identification (Ferreira et al, 2011; Barnini et al, 2015; Tanaka et al, 2017; Florio et al, 2018a).The widespread of multi-drug-resistant bacterial strains, especially in hospital settings, have generated a pressing need for the development of rapid and reliable methods for antimicrobial susceptibility testing (AST), and the potentials of MALDI-TOF MS to achieve this goal have been explored.Multi-drug-resistance is a dramatic problem in systemic infections (Palacios-Baena et al, 2017), and infections involving critical districts [e.g., eye and orbit, where timely administration of an effective therapy is fundamental for sparing organ specific functions or patient survival (Tsirouki et al, 2018; Choi et al, 2019)].a number of studies investigated the possibility to apply MALDI-TOF MS technology to rapid detection of antibiotic-resistance in bacterial pathogens isolated from bloodstream infections as well as to the detection of antimicrobial-resistance in pathogenic fungi (Florio et al, 2018b).AST by MALDI-TOF MSThe present review provides (i) a synthetic, updated overview of the different proposed methods based on MALDI-TOF MS, mainly focusing on its most promising applications and (ii) rapid and accurate information regarding antimicrobial-resistance of clinically relevant bacteria.ASSESSMENT OF β-LACTAMASE ACTIVITY BY MALDI-TOF MS
The MBT-ASTRA is a rapid method for detection of antibioticresistance based on a MALDI-TOF MS software tool that calculates and compares the area under the curves (AUCs) of spectra of bacteria either exposed or not to an antibiotic (Lange et al, 2014; Sparbier et al, 2016)
Piperacillintazobactam, a small number of isolates were misclassified as susceptible by the MBT-ASTRA mostly when MIC values were close to the antibiotic concentration used in the assay. These results indicate that the MBT-ASTRA could be a promising approach for rapid antimicrobial susceptibility testing (AST) of Gram-negative bacteria directly recovered from monomicrobial blood cultures (BCs), and highlight the need to optimize the method, especially for correct classification of isolates with MIC values close to the breakpoint concentrations, and for some antibiotics
Summary
The application of MALDI-TOF MS technology to clinical diagnostic microbiology has provided a new, accurate and robust tool allowing rapid and reliable microbial identification (Ferreira et al, 2011; Barnini et al, 2015; Tanaka et al, 2017; Florio et al, 2018a).The widespread of multi-drug-resistant bacterial strains, especially in hospital settings, have generated a pressing need for the development of rapid and reliable methods for antimicrobial susceptibility testing (AST), and the potentials of MALDI-TOF MS to achieve this goal have been explored.Multi-drug-resistance is a dramatic problem in systemic infections (Palacios-Baena et al, 2017), and infections involving critical districts [e.g., eye and orbit, where timely administration of an effective therapy is fundamental for sparing organ specific functions or patient survival (Tsirouki et al, 2018; Choi et al, 2019)].a number of studies investigated the possibility to apply MALDI-TOF MS technology to rapid detection of antibiotic-resistance in bacterial pathogens isolated from bloodstream infections as well as to the detection of antimicrobial-resistance in pathogenic fungi (Florio et al, 2018b).AST by MALDI-TOF MSThe present review provides (i) a synthetic, updated overview of the different proposed methods based on MALDI-TOF MS, mainly focusing on its most promising applications and (ii) rapid and accurate information regarding antimicrobial-resistance of clinically relevant bacteria.ASSESSMENT OF β-LACTAMASE ACTIVITY BY MALDI-TOF MS. The widespread of multi-drug-resistant bacterial strains, especially in hospital settings, have generated a pressing need for the development of rapid and reliable methods for antimicrobial susceptibility testing (AST), and the potentials of MALDI-TOF MS to achieve this goal have been explored.
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