Korean J Intern Med.  2019 Sep;34(5):1058-1067. 10.3904/kjim.2018.169.

Clinical efficacy of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in patients with multidrug-resistant bacteremia: a single-center study in Korea

• Mok J
• Jo EJ
• Eom JS
• Kim MH
• Kim KU
• Park HK
• Lee MK
• Lee K

• KMID: 2457029
• DOI: http://doi.org/10.3904/kjim.2018.169

Abstract

BACKGROUND/AIMS
Matrix-assisted laser desorption/ionization time-of-f light mass spectrometry (MALDI-TOF MS) is a new diagnostic tool for microorganism identification. The clinical usefulness of this approach has not been widely examined in Korea. This retrospective pre-post-intervention quasi-experimental study examined the effect of MALDI-TOF MS on patients with multidrug-resistant (MDR) bacteremia in the intensive care unit (ICU).
METHODS
All consecutive patients with MDR bacteremia in the ICU of a tertiary care hospital between March 2011 and February 2013 and between March 2014 and February 2016 were enrolled. MALDI-TOF MS was introduced between these periods. In the pre-intervention and intervention groups, microorganisms were identified by conventional means and by MALDI-TOF MS, respectively. The groups were compared in terms of time from venipuncture to microorganism identification and antimicrobial susceptibility test results.
RESULTS
In total, 187 patients (mean age, 61.0 years; 56.7% male) were enrolled. Of these, 97 and 90 were in the pre-intervention and intervention groups, respectively. The intervention group had a significantly shorter time from venipuncture to microorganism identification and antimicrobial susceptibility test results (82.5 ± 21.6 hours vs. 92.3 ± 40.4 hours, p = 0.038). The antibiotics were adjusted in 52 patients (26 each in the pre-intervention and intervention groups) based on these results. These groups did not differ in terms of time from venipuncture to antibiotic adjustment, and multivariate regression analysis showed that MALDI-TOF MS-based microorganism identification was not associated with 28-day mortality.
CONCLUSIONS
Our study showed that MALDI-TOF MS accelerated microorganism identification in patients with MDR bacteremia, but did not inf luence 28-day mortality.

Keyword

Drug resistance; Identification; Intensive care units; Spectrometry, mass, matrix-assisted laser desorption-ionization

MeSH Terms

Anti-Bacterial Agents
Bacteremia*
Drug Resistance
Humans
Intensive Care Units
Korea*
Mass Spectrometry*
Mortality
Non-Randomized Controlled Trials as Topic
Phlebotomy
Retrospective Studies
Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
Tertiary Healthcare
Treatment Outcome*
Anti-Bacterial Agents