MALDI-TOF and Antimicrobial Stewardship

Abstract

The emergence of rapid diagnostic tests for use in clinical microbiology laboratories is revolutionizing the ability to efficiently identify pathogens and resistance mechanisms. Optimizing time to appropriate therapy is crucial and linked to significant improvements in mortality. Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) utilizes mass spectrometry to provide rapid and reliable identification of organisms 1–1.5 days sooner than traditional methods. Further, the literature suggests that involvement of antimicrobial stewardship program initiatives in combination with MALDI-TOF facilitates timely antibiotic adjustments and optimizes clinical outcomes. MALDI-TOF combined with antimicrobial stewardship review and intervention has been associated with improvements in patient care, including improving time to appropriate antibiotic therapy, reduced mortality rates, decreased length of hospitalization, and decreased hospital costs. Antimicrobial stewardship programs (ASPs) can use rapid pathogen identification data to tailor antibiotic therapy to the individual patient through knowledge of local antibiogram data, applying known risk factors for antibiotic resistance and evaluating the patient’s past medical history. Furthermore, a significant economic advantage is possible as studies reveal impressive decreases in total hospital costs when MALDI-TOF was coupled with ASP intervention. Finally, studies evaluating novel uses of MALDI-TOF such as for the detection of antimicrobial resistance and strain typing for epidemiological investigations are underway. These applications will only further expand the range of possible ASP interventions.