Use of matrix-assisted laser desorption ionization time of flight (MALDI-TOF) to detect antibiotic resistance in bacteria: A scoping review

Abstract

Objectives: Matrix-assisted laser desorption ionization time of flight (MALDI-TOF) has revolutionized clinical microbiology laboratories, enabling the identification of microorganisms in minutes. Although this advancement has significantly enhanced patient care by providing early diagnosis, the use of MALDI-TOF for routine detection of antimicrobial resistance (AMR) remains an ongoing area of research. The purpose of this scoping review was to identify and summarize the existing literature on MALDI-TOF-based methodologies for detecting AMR.

Methods: The PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature databases were searched for articles published up to July 2023. Publications were carefully screened, and inclusion was based on their relevance to the topic and detailed explanations of the methodologies employed.

Results: We reviewed 49 articles and identified various MALDI-TOF-based approaches for detecting AMR that we grouped in 2 main categories: (1) bacterial growth detection following a brief incubation with antibiotics and (2) identification of specific mass spectral profiles associated with drug resistance. Recently, the use of machine learning algorithms has been explored to detect characteristic patterns associated with AMR. Thorough evaluation of each study's procedures was conducted to determine their potential for implementation in clinical laboratories.

Conclusions: MALDI-TOF shows promise as a tool for AMR detection, but its readiness for wider clinical adoption relies on ongoing research, development of algorithms and software for automated interpretation of mass spectra, and validation efforts. Its role in routine clinical practice may evolve as technology and knowledge progress.

Keywords: MALDI-TOF; antimicrobial resistance; scoping review.