Intact cell MALDI-TOF mass spectrometry-based approaches for the diagnosis of bloodstream infections

MALDI-TOF mass spectrometry (MS) on intact cells is at the forefront of a new revolution in the routine identification of microorganisms in clinical microbiology laboratories. In addition to its high accuracy for identification, it provides results in just a few minutes. As correct and timely diagnoses are pivotal for the management of bloodstream infections, MALDI-TOF MS has the potential to replace or at least complement other methods for microorganism identification in bloodstream infections. With the improvement of databases and software, this method has an accurate identification rate of nearly 100% on nearly all agar-grown microorganisms and more than 80% on positive blood culture broth tests. Even if it is highly efficient now, after a decade of developments, the technique is currently still under improvement. It lacks standardization and exhaustive databases or more efficient softwares that are currently under development. Even now, both the technology itself and the reagents are improving significantly. Thus, it is likely that identifications will become more accurate in the future, especially on more complex fluids, such as blood culture broth.