MALDI-TOF: Improving Care in Microbiology

A high volume of microbiology specimens did not deter a team of investigators from successfully reducing turnaround time and saving reagent costs and technologists’ time at a VA hospital. The key ingredient? Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF). The team's results were published in the American Journal of Clinical Pathology.

“MALDI-TOF has a significant role in the improvement of patient care with accurate, cost-effective, and rapid identification of the microbes leading to antimicrobial therapy,” they summarized. The technology, which is fairly new, had never been reported in the VA healthcare setting in reference to its benefits and feasibility. Using the Corporal Michael J. Crescenz VA Medical Center (CMCVAMC) in Philadelphia as their base, investigators conducted a 9-month quality assurance study in 2017 to assess MALDI-TOF’s impact on clinical microbiology testing.

Over this time period, they evaluated various lab data elements including specimens, organisms grown, collection sample, and TAT after they implemented MALDI-TOF, comparing results with those collected and processed over the same time period in 2016, prior to MALDI-TOF.

Although 2017’s results yielded 14,349 specimens, a much higher volume than the 12,722 specimens reported in 2016, MALDI-TOF reduced TAT and saved technologists’ time and reagent costs. “Preliminary identifications could be provided through the MALDI-TOF upon adequate colony formation, which provided quicker selection of antimicrobial therapy and cost-effective patient care,” the investigators reported. Some specimen types showed major improvements in time to final report, with times shortening from 11 to 6 days for abscesses, 6 to 4 days for bronchial washes, and 6 to 2 days for Bacteroides fragilis.

Investigators concluded that MALDI-TOF proved its benefits in the VA setting by improving TAT and quality parameters.

As a new technology entering clinical labs, MALDI-TOF has already had a significant impact on patient care, study author Darshana Jhala, MD, professor of clinical pathology and laboratory medicine at the University of Pennsylvania Perelman School of Medicine and chief of pathology and laboratory medicine services at CMCVAMC, told CLN Stat.

Future research plans include looking at a larger patient cohort to see if reducing the TAT to identify clinical isolates from microbiological specimens would lead to shorter hospital inpatient stays and yield substantial savings. “Earlier identification allows more precision targeting of antibiotic therapy—and thus less ecologic pressure toward emergence of resistance as well as the potential of greater efficacy of therapy against the offending organism. Shorter TAT also means that patients get isolated earlier in the event they have a nosocomial infection,” Jhala said. “We also want to focus on how much labor and technologist time we are saving.”

https://www.aacc.org/publications/cln/cln-stat/2018/october/18/maldi-tof-improving-care-in-microbiology