Comparative performance analysis of two matrix-assisted laser desorption/ionization time-of-flight mass spectrometry systems for direct identification of urinary tract pathogens from clinical samples: Direct urinary pathogen ID via MALDI-TOF MS

Merve Ertürk Melez; Mustafa Altay  Atalay; Pınar Sağıroğlu; Fatma Mutlu Sarıgüzel

doi:10.28982/josam.8339

Authors

Merve Ertürk Melez Department of Medical Microbiology, School of Medicine, Erciyes University, 38039 Kayseri, Turkey https://orcid.org/0009-0005-3024-7877
Mustafa Altay Atalay Department of Medical Microbiology, School of Medicine, Erciyes University, 38039 Kayseri, Turkey https://orcid.org/0000-0003-4169-0637
Pınar Sağıroğlu Department of Medical Microbiology, School of Medicine, Erciyes University, 38039 Kayseri, Turkey https://orcid.org/0000-0001-6742-0200
Fatma Mutlu Sarıgüzel Department of Medical Microbiology, School of Medicine, Erciyes University, 38039 Kayseri, Turkey https://orcid.org/0000-0003-2747-0208

DOI:

https://doi.org/10.28982/josam.8339

Keywords:

Urinary tract infection, MALDI-TOF MS, VITEK MS, MALDI Biotyper Sirius, uropathogen, rapid diagnosis

Abstract

Background/Aim: Urinary tract infections (UTIs) are a significant global health concern that necessitates expedited diagnostic methods to guide appropriate antimicrobial treatment and mitigate the spread of multidrug-resistant organisms. This investigation was conducted to assess the effectiveness of two distinct matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) platforms for the direct identification of UTI-causing agents from urine samples: VITEK MS (bioMérieux, France) and MALDI Biotyper Sirius (Bruker Daltonics, Germany). The findings were evaluated by comparison of the outcomes with those of conventional urine culture, which is considered the diagnostic gold standard.

Methods: The study included 60 urine specimens consisting of 40 specimens from patients presenting with UTI symptoms and 20 specimens from a control group that showed no bacterial growth in culture. A differential centrifugation method was employed to prepare the samples, which were subsequently analyzed using both MALDI-TOF MS systems. Concurrently, all samples underwent conventional urine culture.

Results: Among the 40 culture-positive samples, the MALDI Biotyper Sirius system demonstrated an overall identification sensitivity of 69.2% and a specificity of 95.2%. The VITEK MS system showed a sensitivity of 79.5% and a specificity of 95.2%. For the 29 samples with a bacterial concentration of ≥1×105 colony-forming units per milliliter (CFU/mL), the sensitivity was 75.9% for the MALDI Biotyper Sirius system and 79.3% for the VITEK MS system. A statistical evaluation using McNemar's test determined that the difference in sensitivity between the two platforms was not statistically significant (P=0.125).

Conclusion: The findings suggest that both MALDI-TOF MS platforms have considerable promise for the rapid and direct identification of uropathogens, particularly in monomicrobial urine samples with a high bacterial load (≥1×105 CFU/mL). While the VITEK MS system exhibited a marginally higher overall identification sensitivity, the data indicate that both systems can be considered valuable assets in clinical diagnostic laboratories.

Downloads

Download data is not yet available.

References

Oviaño M, Ramírez CL, Barbeyto LP, Bou G. Rapid direct detection of carbapenemase-producing Enterobacteriaceae in clinical urine samples by MALDI-TOF MS analysis. J Antimicrob Chemother. 2017;72(5):1350-4.

Tang M, Yang J, Li Y, Zhang L, Peng Y, Chen W, et al. Diagnostic Accuracy of MALDI-TOF Mass Spectrometry for the Direct Identification of Clinical Pathogens from Urine. Open Med (Wars). 2020; 15:266-73.

Li W, Sun E, Wang Y, Pan H, Zhang Y, Li Y, et al. Rapid Identification and Antimicrobial Susceptibility Testing for Urinary Tract Pathogens by Direct Analysis of Urine Samples Using a MALDI-TOF MS-Based Combined Protocol. Front Microbiol. 2019;10:1182.

Zboromyrska Y, Bosch J, Aramburu J, Cuadros J, García-Riestra C, Guzmán-Puche J, et al. A multicentre study investigating parameters which influence direct bacterial identification from urine. PLoS One. 2018;13(12):e0207822.

Huang B, Zhang L, Zhang W, Liao K, Zhang S, Zhang Z, et al. Direct Detection and Identification of Bacterial Pathogens from Urine with Optimized Specimen Processing and Enhanced Testing Algorithm. J Clin Microbiol. 2017;55(5):1488-95.

Íñigo M, Coello A, Fernández-Rivas G, Rivaya B, Hidalgo J, Quesada MD, et al. Direct Identification of Urinary Tract Pathogens from Urine Samples, Combining Urine Screening Methods and Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry. J Clin Microbiol. 2016;54(4):988-93.

Blondiaux N, Gaillot O, Courcol RJ. MALDI-TOF mass spectrometry to identify clinical bacterial isolates: evaluation in a teaching hospital in Lille. Pathol Biol (Paris).2010;58(1):55-7.

Seng P, Drancourt M, Gouriet F, La Scola B, Fournier PE, Rolain JM, et al. Ongoing revolution in bacteriology: routine identification of bacteria by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Clin Infect Dis. 2009;49(4):543-51.

Mellmann A, Cloud J, Maier T, Keckevoet U, Ramminger I, Iwen P, et al. Evaluation of matrix-assisted laser desorption ionization-time-of-flight mass spectrometry in comparison to 16S rRNA gene sequencing for species identification of nonfermenting bacteria. J Clin Microbiol. 2008;46(6):1946-54.

Marklein G, Josten M, Klanke U, Müller E, Horré R, Maier T, et al. Matrix-assisted laser desorption ionization-time of flight mass spectrometry for fast and reliable identification of clinical yeast isolates. J Clin Microbiol. 2009;47(9):2912-7.

Veron L, Mailler S, Girard V, Muller BH, L'Hostis G, Ducruix C, et al. Rapid urine preparation prior to identification of uropathogens by MALDI-TOF MS. Eur J Clin Microbiol Infect Dis. 2015;34(9):1787-95.

Rodríguez-Sánchez B, Sánchez-Carrillo C, Ruiz A, Marín M, Cercenado E, Rodríguez-Créixems M, et al. Direct identification of pathogens from positive blood cultures using matrix-assisted laser desorption-ionization time-of-flight mass spectrometry. Clin Microbiol Infect. 2014;20(7):421-7.

Haiko J, Savolainen LE, Hilla R, Pätäri-Sampo A. Identification of urinary tract pathogens after 3-hours urine culture by MALDI-TOF mass spectrometry. J Microbiol Methods. 2016;129:81-4.

Ferreira L, Sánchez-Juanes F, González-Avila M, Cembrero-Fuciños D, Herrero-Hernández A, González-Buitrago JM, et al. Direct identification of urinary tract pathogens from urine samples by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2010;48(6):2110-5.

Zboromyrska Y, Rubio E, Alejo I, Vergara A, Mons A, Campo I, et al. Development of a new protocol for rapid bacterial identification and susceptibility testing directly from urine samples. Clin Microbiol Infect. 2016;22(6):561.e1-6.

Burillo A, Rodríguez-Sánchez B, Ramiro A, Cercenado E, Rodríguez-Créixems M, Bouza E. Gram-stain plus MALDI-TOF MS (Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry) for a rapid diagnosis of urinary tract infection. PLoS One. 2014;9(1):e86915.