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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

Korean Journal of Internal Medicine 2019년 34권 5호 p.1058 ~ 1067
 ( Mok Jeong-Ha ) - Pusan National University School of Medicine Department of Internal Medicine

 ( Jo Eun-Jung ) - Pusan National University School of Medicine Department of Internal Medicine
 ( Eom Jung-Seop ) - Pusan National University School of Medicine Department of Internal Medicine
 ( Kim Mi-Hyun ) - Pusan National University School of Medicine Department of Internal Medicine
 ( Kim Ki-Uk ) - Pusan National University School of Medicine Department of Internal Medicine
 ( Park Hye-Kyung ) - Pusan National University School of Medicine Department of Internal Medicine
 ( Lee Min-Ki ) - Pusan National University School of Medicine Department of Internal Medicine
 ( Lee Kwang-Ha ) - Pusan National University School of Medicine Department of Internal Medicine

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.

키워드

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