title: Matrix-assisted Laser Desorption Ionization-Time-of-Flight Mass Spectrometry (MALDI-TOF MS) as a Reliable Tool to Identify Species of Catalase-negative Gram-positive Cocci not Belonging to theStreptococcusGenus.
abstract: OBJECTIVE
  To evaluate the performance of matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) by using 190 Catalase-negative Gram-Positive Cocci (GPC) clinical isolates.
  
  
  METHODS
  All isolates were identified by conventional phenotypic tests following the proposed scheme by Ruoff and Christensen and MALDI-TOF MS (Bruker Daltonics, BD, Bremen, Germany). Two different extraction methods (direct transfer formic acid method on spot and ethanol formic acid extraction method) and different cut-offs for genus/specie level identification were used. The score cut-offs recommended by the manufacturer (≥ 2.000 for species-level, 1.700 to 1.999 for genus level and <1.700 no reliable identification) and lower cut-off scores (≥1.500 for genus level, ≥ 1.700 for species-level and score <1.500 no reliable identification) were considered for identification. A minimum difference of 10% between the top and next closest score was required for a different genus or species. MALDI-TOF MS identification was considered correct when the result obtained from MS database agreed with the phenotypic identification result. When both methods gave discordant results, the 16S rDNA orsodAgenes sequencing was considered as the gold standard identification method. The results obtained by MS concordant with genes sequencing, although discordant with conventional phenotyping, were considered correct. MS results discordant with 16S orsodA identification were considered incorrect.
  
  
  RESULTS
  Using the score cut-offs recommended by the manufacturer, 97.37% and 81.05% were correctly identified to genus and species level, respectively. On the other hand, using lower cut-off scores for identification, 97.89% and 94.21% isolates were correctly identified to genus and species level respectively by MALDI-TOF MS and no significant differences between the results obtained with two extraction methods were obtained.
  
  
  CONCLUSIONS
  The results obtained suggest that MALDI-TOF MS has the potential of being an accurate tool for Catalase-negative GPC identification even for those species with difficult diagnosis asHelcococcus,Abiotrophia,Granulicatella, among others. Nevertheless, expansion of the library, especially including more strains with different spectra on the same species might overcome potential "intraspecies" variability problems. Moreover, a decrease of the identification scores for species and genus-level identification must be considered since it may improve the MALDI-TOF MS accuracy.
authors.affiliation: Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Departamento de Bioquímica Clínica Hospital de Clínicas José de San Martín Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Marisa
authors.initials: M
authors.lastname: Almuzara
authors.affiliation: Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Departamento de Bioquímica Clínica Hospital de Clínicas José de San Martín Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Claudia
authors.initials: C
authors.lastname: Barberis
authors.affiliation: Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Departamento de Bioquímica Clínica Hospital de Clínicas José de San Martín Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Viviana Rojas
authors.initials: VR
authors.lastname: Velázquez
authors.affiliation: Center for Applied Biotechnology Studies, Department of Biological Science, California State University Fullerton, Fullerton, CA, USA.
authors.forename: Maria Soledad
authors.initials: MS
authors.lastname: Ramirez
authors.affiliation: Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Departamento de Bioquímica Clínica Hospital de Clínicas José de San Martín Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Angela
authors.initials: A
authors.lastname: Famiglietti
authors.affiliation: Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Departamento de Bioquímica Clínica Hospital de Clínicas José de San Martín Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vay
keywords: Catalase-negative gram-positive Cocci; Enterococcus spp; Identification; MALDI-TOF MS