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A systematic review of matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry compared to routine microbiological methods for the time taken to identify microbial organisms from positive blood cultures

  • P. Dixon
  • P. Davies
  • W. Hollingworth
  • M. Stoddart
  • A. MacGowan
Review

Abstract

Bloodstream infections are a significant source of mortality and morbidity. Patient outcomes are improved by rapid identification of the causative pathogen and administration of appropriate antimicrobial therapy. Matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry has recently emerged as an alternative to microbiological identification. It is important to establish whether the costs of MALDI-TOF are justified by more timely identification and appropriate therapy, reduced length of stay and reduced hospital costs. We undertook a systematic review of the literature comparing MALDI-TOF and routine methods for the identification of the aetiological agent in patients with known or suspected bloodstream infection. The primary outcome of the review was the ‘time to identify’ organisms. Information on related measures such as ‘time to appropriate antimicrobial treatment’ and downstream hospital cost was also collected where reported. Ten of 775 articles identified met the inclusion criteria. All included studies were observational. MALDI-TOF identification was at least 24 h faster than routine methods in most circumstances. MADLI-TOF was associated with a reduction in downstream hospital costs and length of stay in studies reporting these outcomes. The observational studies reviewed provide evidence of potentially substantial time savings of MALDI-TOF in pathogen identification and instigation of appropriate therapy, which may also reduce hospital stay. Due to the small number of studies, all at relatively high risk of bias, this cannot be considered as definitive evidence of the impact of MALDI-TOF. More and better evidence, including impact on patient health and cost-effectiveness, is required.

Keywords

Bloodstream Infection Routine Method Total Hospital Cost Routine Identification Comparator Technology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

There are no conflicts of interest.

Supplementary material

10096_2015_2322_MOESM1_ESM.docx (16 kb)
Online Resource 1 Search protocols for the systematic review (DOCX 15 kb)
10096_2015_2322_MOESM2_ESM.doc (66 kb)
Completed PRISMA checklist for systematic reviews (DOC 66 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • P. Dixon
    • 1
  • P. Davies
    • 1
  • W. Hollingworth
    • 1
  • M. Stoddart
    • 2
  • A. MacGowan
    • 3
  1. 1.School of Social and Community MedicineUniversity of BristolBristolUK
  2. 2.North Bristol NHS Trust, Department of Medical MicrobiologySouthmead HospitalBristolUK
  3. 3.Bristol Centre for Antimicrobial Research and Evaluation, University of Bristol and North Bristol NHS Trust, Department of Medical MicrobiologySouthmead HospitalBristolUK

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