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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

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MALDI-TOFMS-oriented early definitive therapy improves the optimal use of antibiotics for Enterococcus spp.

Yuki Shimamoto1, Hiroaki Araie2, Kazuhiro Itoh3

  • 1Department of Nephrology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|January 27, 2021
PubMed

Insights

Matrix-assisted laser desorption and ionization time-of-flight mass spectrometry (MALDI-TOFMS) significantly speeds up antibiotic treatment for enterococcal bloodstream infections (BSI). While mortality and hospitalization length remained unchanged, MALDI-TOFMS shows potential for shorter treatment durations.

Area of Science:

  • Clinical Microbiology
  • Infectious Diseases
  • Medical Diagnostics

Background:

  • Enterococci are a primary cause of bloodstream infections (BSI).
  • Intrinsic drug resistance in enterococci often leads to inappropriate empiric antibiotic therapy.
  • Rapid and accurate identification of pathogens is crucial for effective treatment.

Purpose of the Study:

  • To evaluate the impact of Matrix-assisted laser desorption and ionization time-of-flight mass spectrometry (MALDI-TOFMS) on early antibiotic treatment for enterococcal infections.
  • To investigate the effects of MALDI-TOFMS on 28-day mortality, hospitalization length, and antibiotic treatment duration in patients with enterococcal bacteremia.

Main Methods:

  • A single-center retrospective cohort study involving 173 BSI episodes (172 patients) from June 2012 to June 2019.
  • Patients were divided into two groups: before (Control group, n=82) and after (MALDI-TOF group, n=91) the implementation of MALDI-TOFMS.
  • Comparison of time to definitive antibiotic treatment, 28-day mortality, length of hospitalization, and duration of antibiotic treatment between the groups.

Main Results:

  • Implementation of MALDI-TOFMS significantly reduced the time to definitive antibiotic treatment (median 3 days vs. 1 day, p < 0.001).
  • No significant differences were observed in 28-day mortality (29.3% vs. 26.4%, p=0.63) or length of hospitalization (median 16 vs. 19 days, p=0.58).
  • The duration of antibiotic treatment did not significantly differ (median 11 vs. 11 days, p=0.78), although it tended to be shorter in older patients within the MALDI-TOF group.

Conclusions:

  • MALDI-TOFMS significantly accelerates the time to definitive antibiotic treatment for enterococcal bloodstream infections.
  • While key clinical outcomes like mortality and hospitalization duration were not significantly altered, the diagnostic speed offers advantages.
  • Further research may explore optimizing antibiotic duration based on rapid diagnostics, potentially shortening treatment courses.
Keywords:
Bloodstream infectionEnterococcus faecalisEnterococcus faeciumMALDI-TOFMS

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