Ann Lab Med.  2017 May;37(3):223-230. 10.3343/alm.2017.37.3.223.

Comparison of the Bruker Biotyper and VITEK MS Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry Systems Using a Formic Acid Extraction Method to Identify Common and Uncommon Yeast Isolates

  • 1Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea.


Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) allows rapid and accurate identification of clinical yeast isolates. In-tube formic acid/acetonitrile (FA/ACN) extraction is recommended prior to the analysis with MALDI Biotyper, but the direct on-plate FA extraction is simpler. We compared the Biotyper with the VITEK MS for the identification of various clinically relevant yeast species, focusing on the use of the FA extraction method.
We analyzed 309 clinical isolates of 42 yeast species (four common Candida species, Cryptococcus neoformans, and 37 uncommon yeast species) using the Biotyper and VITEK MS systems. FA extraction was used initially for all isolates. If "˜no identification' result was obtained following the initial FA extraction, these samples were then retested by using FA (both systems, additive FA) or FA/ACN (Biotyper only, additive FA/ACN) extraction. These results were compared with those obtained by sequence-based identification.
Both systems correctly identified all 158 isolates of the four common Candida species after the initial FA extraction. The Biotyper correctly identified 8.7%, 30.4%, and 100% of 23 C. neoformans isolates after performing initial FA, additive FA, and FA/ACN extractions, respectively, while VITEK MS identified all C. neoformans isolates after the initial FA extraction. Both systems had comparable identification rates of 37 uncommon yeast species (128 isolates), following the initial FA (Biotyper, 74.2%; VITEK MS, 73.4%) or additive FA (Biotyper, 82.0%; VITEK MS, 73.4%).
The identification rate of most common and uncommon yeast isolates is comparable between simple FA extraction/Biotyper method and VITEK MS methods, but FA/ACN extraction is necessary for C. neoformans identification by Biotyper.


Matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS); VITEK MS; Biotyper; Yeast; Candida; Formic acid extraction

MeSH Terms

Cryptococcus neoformans
Mass Spectrometry*
Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

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1. Azie N, Neofytos D, Pfaller M, Meier-Kriesche HU, Quan SP, Horn D. The PATH (Prospective Antifungal Therapy) Alliance® registry and invasive fungal infections: update 2012. Diagn Microbiol Infect Dis. 2012; 73:293–300. PMID: 22789847.
2. Bitar D, Lortholary O, Le Strat Y, Nicolau J, Coignard B, Tattevin P, et al. Population-based analysis of invasive fungal infections, France, 2001-2010. Emerg Infect Dis. 2014; 20:1149–1155. PMID: 24960557.
3. Chen SC, Marriott D, Playford EG, Nguyen Q, Ellis D, Meyer W, et al. Candidaemia with uncommon Candida species: predisposing factors, outcome, antifungal susceptibility, and implications for management. Clin Microbiol Infect. 2009; 15:662–669. PMID: 19614718.
4. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev. 2007; 20:133–163. PMID: 17223626.
5. Lockhart SR, Iqbal N, Cleveland AA, Farley MM, Harrison LH, Bolden CB, et al. Species identification and antifungal susceptibility testing of Candida bloodstream isolates from population-based surveillance studies in two U.S. cities from 2008 to 2011. J Clin Microbiol. 2012; 50:3435–3442. PMID: 22875889.
6. Hajjeh RA, Sofair AN, Harrison LH, Lyon GM, Arthington-Skaggs BA, Mirza SA, et al. Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program. J Clin Microbiol. 2004; 42:1519–1527. PMID: 15070998.
7. Pence MA, McElvania TeKippe E, Wallace MA, Burnham CA. Comparison and optimization of two MALDI-TOF MS platforms for the identification of medically relevant yeast species. Eur J Clin Microbiol Infect Dis. 2014; 33:1703–1712. PMID: 24800928.
8. Mancini N, De Carolis E, Infurnari L, Vella A, Clementi N, Vaccaro L, et al. Comparative evaluation of the Bruker Biotyper and Vitek MS matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry systems for identification of yeasts of medical importance. J Clin Microbiol. 2013; 51:2453–2457. PMID: 23678071.
9. Chao QT, Lee TF, Teng SH, Peng LY, Chen PH, Teng LJ, et al. Comparison of the accuracy of two conventional phenotypic methods and two MALDI-TOF MS systems with that of DNA sequencing analysis for correctly identifying clinically encountered yeasts. PLoS One. 2014; 9:e109376. PMID: 25330370.
10. Cassagne C, Normand AC, L'Ollivier C, Ranque S, Piarroux R. Performance of MALDI-TOF MS platforms for fungal identification. Mycoses. 2016; 59:678–690. PMID: 27061755.
11. Bader O. MALDI-TOF-MS-based species identification and typing approaches in medical mycology. Proteomics. 2013; 13:788–799. PMID: 23281257.
12. Vlek A, Kolecka A, Khayhan K, Theelen B, Groenewald M, Boel E, et al. Interlaboratory comparison of sample preparation methods, database expansions, and cutoff values for identification of yeasts by matrix-assisted laser desorption ionization-time of flight mass spectrometry using a yeast test panel. J Clin Microbiol. 2014; 52:3023–3029. PMID: 24920782.
13. Cassagne C, Cella AL, Suchon P, Normand AC, Ranque S, Piarroux R. Evaluation of four pretreatment procedures for MALDI-TOF MS yeast identification in the routine clinical laboratory. Med Mycol. 2013; 51:371–377. PMID: 22978312.
14. Theel ES, Schmitt BH, Hall L, Cunningham SA, Walchak RC, Patel R, et al. Formic acid-based direct, on-plate testing of yeast and Corynebacterium species by Bruker Biotyper matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2012; 50:3093–3095. PMID: 22760034.
15. Won EJ, Shin JH, Kim MN, Choi MJ, Joo MY, Kee SJ, et al. Evaluation of the BD Phoenix system for identification of a wide spectrum of clinically important yeast species: a comparison with Vitek 2-YST. Diagn Microbiol Infect Dis. 2014; 79:477–480. PMID: 24952986.
16. Wang W, Xi H, Huang M, Wang J, Fan M, Chen Y, et al. Performance of mass spectrometric identification of bacteria and yeasts routinely isolated in a clinical microbiology laboratory using MALDI-TOF MS. J Thorac Dis. 2014; 6:524–533. PMID: 24822114.
17. Stevenson LG, Drake SK, Shea YR, Zelazny AM, Murray PR. Evaluation of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of clinically important yeast species. J Clin Microbiol. 2010; 48:3482–3486. PMID: 20668126.
18. McTaggart LR, Lei E, Richardson SE, Hoang L, Fothergill A, Zhang SX. Rapid identification of Cryptococcus neoformans and Cryptococcus gattii by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2011; 49:3050–3053. PMID: 21653762.
19. Thomaz DY, Grenfell RC, Vidal MS, Giudice MC, Del Negro GM, Juliano L, et al. Does the capsule interfere with performance of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of Cryptococcus neoformans and Cryptococcus gattii? J Clin Microbiol. 2016; 54:474–477. PMID: 26659203.
20. Gorton RL, Seaton S, Ramnarain P, McHugh TD, Kibbler CC. Evaluation of a short, on-plate formic acid extraction method for matrix-assisted laser desorption ionization-time of flight mass spectrometry-based identification of clinically relevant yeast isolates. J Clin Microbiol. 2014; 52:1253–1255. PMID: 24478407.
21. Won EJ, Shin JH, Lee WK, Koo SH, Kim SY, Park YJ, et al. Distribution of yeast and mold species isolated from clinical specimens at 12 hospitals in Korea during 2011. Ann Clin Microbiol. 2013; 16:92–100.
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