MALDI-ToF short incubation identification from blood cultures is associated with reduced length of hospitalization and a decrease in bacteremia associated mortality

  • J. A. DelportEmail author
  • A. Strikwerda
  • A. Armstrong
  • D. Schaus
  • M. John
Original Article


The purpose of this study was to assess the impact of MALDI-ToF identification and rapid short incubation MALDI-Tof identification protocol on patient care compared to conventional identification. By using a retrospective review we assessed the impact of a rapid Bruker MALDI-Tof identification protocol. Overall there was a 16.76-hour reduction in time to identification of the pathogen after the introduction of MALDI-TOF identification in 2013 (P<0.0001) and a further 15-hour reduction (P<9.37 E-05) after implementation of the short incubation MALDI-TOF identification protocol in 2014. Patients received appropriate therapy 20.25 hours earlier (P<0.002) in 2014 compared to the conventional identification group in 2012. Overall length in the patients needing optimization of antibiotic treatment was reduced by 6.87 days (P<0.042). In 2014 outcomes between the patients needing a change in their antibiotic compared to the patients where the empirical therapy was considered to be optimal were similar with respective difference in length of stay being reduced from 4.72 days (P<0.031) to 1.77 days (P<0.71) and an associated reduction in the absolute mortality risk of 3.79%. The all-cause mortality rate was twice as high in the group pre-implementation of the short incubation MALDI-TOF identification with an associated survival benefit in this patient population when 26 patients were treated. Rapid short incubation MALDI-ToF identification of bacterial pathogens in blood cultures is associated with a reduction in length of stay and mortality risk.


Empirical Therapy Empirical Antibiotic Therapy Antimicrobial Stewardship Program Laboratory Information System Pathogen Identification 
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.


Compliance with ethical standards

The study was submitted as part of a quality improvement initiative to the Office of Research Ethics, Western University, London, Ontario (Research and Ethics number 106659). In accordance with the Tri-Council Policy Statement 2: Ethical Conduct of Research Involving Humans, Article 2.5 ethics approval and informed consent were waived as the study was deemed to fulfill the criteria for a quality improvement project. No external funding was received to complete the project and none of the authors reported any conflicts of interest. All data were de-identified by the primary investigator prior to analysis and are stored in a secure location.


  1. 1.
    Mandell LA, Wunderink RG, Anzueto A et al (2009) Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44(Suppl 2):S27–72Google Scholar
  2. 2.
    American Thoracic Society, Infectious Diseases Society of America (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416CrossRefGoogle Scholar
  3. 3.
    Bodmann KF (2005) Current guidelines for the treatment of severe pneumonia and sepsis. Chemotherapy 51:227–233CrossRefPubMedGoogle Scholar
  4. 4.
    Shlaes DM, Gerding DN, John JF Jr et al (1997) Society for healthcare epidemiology of America and infectious diseases society of America joint committee on the prevention of antimicrobial resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis 25:584–599CrossRefPubMedGoogle Scholar
  5. 5.
    Dellit TH, Owens RC, McGowan JE Jr et al (2007) Infectious diseases society of America and the society for healthcare epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 44:159–177CrossRefPubMedGoogle Scholar
  6. 6.
    Verroken A, Defourny L, Lechgar L, Magnette A, Delmée M, Glupczynski Y (2015) Reducing time to identification of positive blood cultures with MALDI-TOF MS analysis after a 5-h subculture. Eur J Clin Microbiol Infect Dis 34:405–413CrossRefPubMedGoogle Scholar
  7. 7.
    Zabbe JB, Zanardo L, Mégraud F, Bessède E (2015) MALDI-TOF mass spectrometry for early identification of bacteria grown in blood culture bottles. J Microbiol Methods 115:45–46CrossRefPubMedGoogle Scholar
  8. 8.
    Dellinger RP, Levy MM, Rhodes A et al (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41:580–637CrossRefPubMedGoogle Scholar
  9. 9.
    Bryan CS, Reynolds KL, Brenner ER (1983) Analysis of 1,186 episodes of gram-negative bacteremia in non- university hospitals: the effects of antimicrobial therapy. Rev Infect Dis 5:629–638CrossRefPubMedGoogle Scholar
  10. 10.
    Glauser MP, Zanetti G, Baumgartner JD, Cohen J (1991) Septic shock: pathogenesis. Lancet 338:732–736CrossRefPubMedGoogle Scholar
  11. 11.
    Fraser A, Paul M, Almanasreh N et al (2006) Benefit of appropriate empirical antibiotic treatment: thirty-day mortality and duration of hospital stay. Am J Med 119:970–976CrossRefPubMedGoogle Scholar
  12. 12.
    Odetola FO, Gebremariam A, Freed GL (2007) Patient and hospital correlates of clinical outcomes and resource utilization in severe pediatric sepsis. Pediatrics 119:487–494CrossRefPubMedGoogle Scholar
  13. 13.
    Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377CrossRefPubMedGoogle Scholar
  14. 14.
    Perez K, Randall J, Olsen RJ et al (2013) Integrating rapid pathogen identification and antimicrobial stewardship significantly decreases hospital costs. Arch Pathol Lab Med 137:1247–1254CrossRefPubMedGoogle Scholar
  15. 15.
    Kohlmann R, Hoffmann A, Geisb G, Gatermann G (2015) MALDI-TOF mass spectrometry following short incubation on a solid medium is a valuable tool for rapid pathogen identification from positive blood cultures. Int J Med Microbiol 305:469–479CrossRefPubMedGoogle Scholar
  16. 16.
    Kollef MH, Sherman G, Ward S, Fraser VJ (1999) Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 115:462–474 Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • J. A. Delport
    • 1
    • 2
    • 3
    • 4
    Email author
  • A. Strikwerda
    • 2
    • 4
  • A. Armstrong
    • 1
  • D. Schaus
    • 1
  • M. John
    • 1
    • 2
    • 4
  1. 1.Division of Microbiology, Pathology and Laboratory MedicineLondon Health Sciences CentreLondonCanada
  2. 2.Schulich School of Medicine and DentistryWestern UniversityLondonCanada
  3. 3.Department of Microbiology and Immunology, Schulich School of Medicine and DentistryWestern UniversityLondonCanada
  4. 4.Clinical Skills Building, Schulich School of Medicine and DentistryWestern UniversityLondonCanada

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