title: Impact of MALDI-TOF-MS-based identification directly from positive blood cultures on patient management: a controlled clinical trial.
abstract: OBJECTIVE
  Rapid identification of pathogens directly from positive blood cultures (BC) in combination with an antimicrobial stewardship programme (ASP) is associated with improved antibiotic treatment and outcomes, but the effect of each individual intervention is less clear. The current study investigated the impact of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) versus conventional identification on antibiotic management in a setting with a well-established ASP and low resistance rates.
  
  
  METHODS
  In this single-centre open label, controlled clinical trial 425 patients with positive BCs were allocated by weekday during a 1-year period to either MALDI-TOF directly from positive BCs or conventional processing. ASP was identical throughout the study period. The primary outcome was duration of intravenous antimicrobial therapy and was analysed in an intention-to-treat approach.
  
  
  RESULTS
  In all, 368 patients were analysed (MALDI-TOF n = 168; conventional n = 200) with similar baseline characteristics. Mean duration of intravenous antimicrobial therapy (12.9 versus 13.2 days, p 0.9) and length of stay (16.1 versus 17.9 days, p 0.3) were comparable. In the clinically significant bloodstream infection subgroup (n = 242) mean time from Gram-stain to active treatment was significantly shorter (3.7 versus 6.7 h, p 0.003). Admission to the intensive care unit after bloodstream infection onset was less frequent in the MALDI-TOF group (23.1 versus 37.2%, p 0.02).
  
  
  CONCLUSIONS
  Rapid identification of contaminated BCs (n = 126) resulted in a shorter duration of intravenous antimicrobial therapy (mean 4.8 versus 7.5 days, p 0.04). Rapid identification using MALDI-TOF directly from positive BCs did not impact on duration of intravenous antimicrobial therapy, but provided fast and reliable microbiological results and may improve treatment quality in the setting of an established ASP.
authors: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors: M
authors: M
authors: Osthoff
authors: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors: N
authors: N
authors: Gürtler
authors: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors: S
authors: S
authors: Bassetti
authors: Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland.
authors: G
authors: G
authors: Balestra
authors: Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland.
authors: S
authors: S
authors: Marsch
authors: Surgical Intensive Care Unit, University Hospital Basel, Basel, Switzerland.
authors: H
authors: H
authors: Pargger
authors: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors: M
authors: M
authors: Weisser
authors: Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland. Electronic address: adrian.egli@usb.ch.
authors: A
authors: A
authors: Egli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D000071997:Blood Culture / Q000379:methods; D015897:Comorbidity; D018849:Controlled Clinical Trials as Topic; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents
keywords: Antibiotic stewardship; Bloodstream infection; Contamination; Matrix-assisted laser desorption/ionization-time of flight mass spectrometry; Sepsis