title: Implementation of short incubation MALDI-TOF MS identification from positive blood cultures in routine diagnostics and effects on empiric antimicrobial therapy.
abstract: BACKGROUND
  Results of blood culture (BC) diagnostics should be swiftly available to guide treatment of critically ill patients. Conventional BC diagnostics usually performs species identification of microorganisms from mature solid medium colonies. Species identification might be speed up by using matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) of biomass from shortly incubated solid media.
  
  
  METHODS
  This single-center analysis compared the applicability of MALDI-TOF-based species identification from shortly incubated cultures in laboratory routine vs. conventional diagnostics and assessed its effects of on empiric antibiotic therapy.
  
  
  RESULTS
  Median time between detection of BCs as "positive" by incubators and further processing (e.g. microscopy) was 6 h 21 min. Median time between microscopy and result reporting to the ward was 15 min. Including 193 BCs, MALDI-TOF from shortly incubated biomass resulted in significantly faster (p> 0.001) species identification. Species results became available for clinicians after a median of 188 min (231 min for Gram-positive bacteria, 151 min for Gram-negative bacteria) compared to 909 min (n= 192 BCs) when conventional diagnostics was used. For 152/179 bacteremia episodes (85%) empiric antibiotic therapy had already been started when the microscopy result was reported to the ward; microscopy led to changes of therapies in 14/179 (8%). In contrast, reporting the bacterial species (without antibiogram) resulted in therapeutic adjustments in 36/179 (20%). Evaluating these changes revealed improved therapies in 26/36 cases (72%).
  
  
  CONCLUSIONS
  Species identification by MALDI-TOF MS from shortly incubated subcultures resulted in adjustments of empiric antibiotic therapies and might improve the clinical outcome of septic patients.
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster, Domagkstr. 10, 48149 Münster, Germany ; Present address: Institute of Hospital Hygiene, University of Oldenburg, European Medical School Oldenburg-Groningen, Rahel-Straus-Str. 10, 26133 Oldenburg, Germany.
authors.forename: Robin
authors.identifier: 0000-0001-7471-5912
authors.initials: R
authors.lastname: Köck
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster, Domagkstr. 10, 48149 Münster, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Wüllenweber
authors.affiliation: Pharmacy Department, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Horn
authors.affiliation: Department for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Lanckohr
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster, Domagkstr. 10, 48149 Münster, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Becker
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster, Domagkstr. 10, 48149 Münster, Germany.
authors.forename: Evgeny A
authors.initials: EA
authors.lastname: Idelevich
keywords: Antibiotic stewardship; Blood culture; Diagnostics; MALDI-TOF MS; Sepsis