Quality of MALDI-TOF mass spectra in routine diagnostics: results from an international external quality assessment including 36 laboratories from 12 countries using 47 challenging bacterial strains

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  • Aline Cuénod
  • Martina Aerni
  • Claudia Bagutti
  • Banu Bayraktar
  • Efe Serkan Boz
  • Cynthia Beisert Carneiro
  • Carlo Casanova
  • Alix T. Coste
  • Damborg, Peter Panduro
  • Dirk W. van Dam
  • Mehmet Demirci
  • Pavel Drevinek
  • Olivier Dubuis
  • José Fernandez
  • Gilbert Greub
  • Jaroslav Hrabak
  • Gülen Hürkal Yiğitler
  • Jakub Hurych
  • Thøger Gorm Jensen
  • Géraldine Jost
  • Greetje A. Kampinga
  • Sonja Kittl
  • Christine Lammens
  • Claudia Lang
  • Reto Lienhard
  • Julie Logan
  • Carola Maffioli
  • Ivana Mareković
  • Matthias Marschal
  • Jacob Moran-Gilad
  • Oliver Nolte
  • Michael Oberle
  • Michael Pedersen
  • Valentin Pflüger
  • Sigrid Pranghofer
  • Julia Reichl
  • Rob J. Rentenaar
  • Arnaud Riat
  • Belén Rodríguez-Sánchez
  • Camille Schilt
  • Ann Kathrin Schlotterbeck
  • Jacques Schrenzel
  • Shani Troib
  • Elise Willems
  • Mandy Wootton
  • Dominik Ziegler
  • Adrian Egli
  • for the ESGMD study group

Objectives: Matrix assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) is a widely used method for bacterial species identification. Incomplete databases and mass spectral quality (MSQ) still represent major challenges. Important proxies for MSQ are the number of detected marker masses, reproducibility, and measurement precision. We aimed to assess MSQs across diagnostic laboratories and the potential of simple workflow adaptations to improve it. Methods: For baseline MSQ assessment, 47 diverse bacterial strains, which are challenging to identify by MALDI-TOF MS, were routinely measured in 36 laboratories from 12 countries, and well-defined MSQ features were used. After an intervention consisting of detailed reported feedback and instructions on how to acquire MALDI-TOF mass spectra, measurements were repeated and MSQs were compared. Results: At baseline, we observed heterogeneous MSQ between the devices, considering the median number of marker masses detected (range = [2–25]), reproducibility between technical replicates (range = [55%–86%]), and measurement error (range = [147 parts per million (ppm)–588 ppm]). As a general trend, the spectral quality was improved after the intervention for devices, which yielded low MSQs in the baseline assessment as follows: for four out of five devices with a high measurement error, the measurement precision was improved (p-values <0.001, paired Wilcoxon test); for six out of ten devices, which detected a low number of marker masses, the number of detected marker masses increased (p-values <0.001, paired Wilcoxon test). Discussion: We have identified simple workflow adaptations, which, to some extent, improve MSQ of poorly performing devices and should be considered by laboratories yielding a low MSQ. Improving MALDI-TOF MSQ in routine diagnostics is essential for increasing the resolution of bacterial identification by MALDI-TOF MS, which is dependent on the reproducible detection of marker masses. The heterogeneity identified in this external quality assessment (EQA) requires further study.

OriginalsprogEngelsk
TidsskriftClinical Microbiology and Infection
Vol/bind29
Udgave nummer2
Sider (fra-til)190-199
ISSN1198-743X
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
We thank Dr. Vladimira Hinic, Dr. Fanny Wegner, Dr. Helena Seth-Smith, and Dr. Marco Meola for valuable feedback on this manuscript. We thank Valerie Courtet and Daniel Gander (University Hospital of Basel, Basel, Switzerland); Dr. Orli Sagi and Dr. Boris Khalfin (Soroka University Medical Center, Beersheva, Israel); Manja Ipsen Hanegård and Tony Bønnelycke (University of Copenhagen, Copenhagen, Denmark); Ivana Jozić and Neno Petrić (University Hospital Centre Zagreb, Croatia); Alison Kolaru and Milena Antuskova (Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic); Stefanie Müller, Simon Feyer and Estelle Gohl (Institute of Veterinary Bacteriology, University of Bern, Bern, Switzerland); Jris Wyss (Institute for Infectious Diseases, University of Bern, Switzerland); Myriam Corthesy (Institute of Microbiology, University Hospital Lausanne, Switzerland); Eliane Haessler, Michael Trouessin and Pierre Glükler (Viollier AG) and Annette Wittmers (University Hospital Freiburg, Freiburg im Breisgau, Germany), Roxanne Mouchet and Dr. Samuel Lüdin (Mabritec AG) for technical support and acquiring MALDI-TOF mass spectra at their respective centre. Further, we would like to thank Dr. Victoria Girard (bioMérieux, Marcy l’Étoile, France) for providing us access to the VitekMS database and technical consultancy as well as Ilona Mossbrugger (Bruker Daltonics, Bremen, Germany) for technical consultancy.

Funding Information:
This study was supported by the two Cantons of Basel through a D-BSSE-Uni-Basel Personalised Medicine grant from the ETH Zurich (PMB-03-17, A.C. and A.E.) and a Doc.Mobility fellowship by the Swiss National Science Foundation (P1BSP3-184342, A.C.).

Publisher Copyright:
© 2022 The Authors

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