title: Use of matrix-assisted laser desorption ionization-time of flight mass spectrometry to resolve complex clinical cases of patients with recurrent bacteremias.
abstract: Matrix-assisted laser desorption-ionization time of flight mass spectrometry (MALDI-TOF MS) is a rapid and accurate method of identifying microorganisms. Throughout Europe, it is already in routine use but has not yet been widely implemented in the United States, pending FDA approval. Here, we describe two medically complex patients at a large tertiary-care academic medical center with recurring bacteremias caused by distinct but related species. Bacterial identifications were initially obtained using the Vitek-2 system with the GPI card for Enterococcus and the API system for staphylococci. Initial results misled clinicians as to the source and proper management of these patients. Retrospective investigation with MALDI-TOF MS clarified the diagnosis by identifying a single microorganism as the pathogen in each case. To our knowledge, this is one of the first reports in the United States demonstrating the use of MALDI-TOF MS to facilitate the clinical diagnosis in patients with recurrent bacteremias of unclear source.
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Priya
authors.initials: P
authors.lastname: Nori
authors.forename: Belinda
authors.initials: B
authors.lastname: Ostrowsky
authors.forename: Olena
authors.initials: O
authors.lastname: Dorokhova
authors.forename: Philip
authors.initials: P
authors.lastname: Gialanella
authors.forename: Morgan
authors.initials: M
authors.lastname: Moy
authors.forename: Victoria
authors.initials: V
authors.lastname: Muggia
authors.forename: Robert
authors.initials: R
authors.lastname: Grossberg
authors.forename: John
authors.initials: J
authors.lastname: Kornblum
authors.forename: Ying
authors.initials: Y
authors.lastname: Lin
authors.forename: Michael H
authors.initials: MH
authors.lastname: Levi
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology*; D001431:Bacteriological Techniques / Q000379:methods*; D016983:Enterococcus / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology*; D006801:Humans; D008297:Male; D012008:Recurrence; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization / Q000379:methods*; D062606:Tertiary Care Centers; D014481:United States; D055815:Young Adult
references.citation: J Clin Microbiol. 2010 May;48(5):1549-54
references.pmid: 20220166
references.citation: Clin Microbiol Infect. 2011 Jan;17(1):44-9
references.pmid: 20132252
references.citation: J Clin Microbiol. 2010 Mar;48(3):900-7
references.pmid: 20053859
references.citation: J Clin Microbiol. 2007 Jul;45(7):2156-61
references.pmid: 17507519
references.citation: J Mol Diagn. 2012 Sep;14(5):419-23
references.pmid: 22795961
references.citation: J Clin Microbiol. 2010 Mar;48(3):941-5
references.pmid: 20032251
references.citation: Clin Microbiol Infect. 2010 Nov;16(11):1614-9
references.pmid: 20636422
references.citation: Eur J Clin Microbiol Infect Dis. 1991 Sep;10(9):745-7
references.pmid: 1810727
references.citation: J Clin Microbiol. 2012 Mar;50(3):927-37
references.pmid: 22205812
references.citation: Future Microbiol. 2010 Nov;5(11):1733-54
references.pmid: 21133692
references.citation: Appl Microbiol Biotechnol. 2012 Feb;93(3):965-74
references.pmid: 22198716
references.citation: Arch Pathol Lab Med. 2013 Sep;137(9):1247-54
references.pmid: 23216247
references.citation: Clin Infect Dis. 2009 Aug 15;49(4):543-51
references.pmid: 19583519
references.citation: Jpn J Infect Dis. 2011;64(4):327-9
references.pmid: 21788710