Experimental study on factors influencing low identification rates and spectral quality of Streptococcus pneumoniae...

The MBT Sepsityper Kit (Sepsityper) has a low identification rate for Streptococcus pneumoniae, and the underlying causes remain unclear. To elucidate these factors, we investigated five factors under controlled conditions simulating bloodstream infections: blood culture bottle type, blood culture system, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) platform, lysis buffer volume used in Sepsityper, and sample preparation method used for MALDI-TOF MS analysis. The results showed that anaerobic bottles had a higher identification rate than aerobic bottles (5.6% vs 0%); however, no significant differences were observed for other factors. Replacement of the lysis and washing buffers with phosphate-buffered saline (PBS) in the Sepsityper was also performed. Replacing the lysis buffer with PBS improved the identification rates compared to unmodified protocols or replacing only the washing buffer. Groups without the lysis buffer exhibited typical gram-positive morphology on Gram staining, whereas those with the lysis buffer showed predominantly swollen gram-negative morphology. Further evaluations of blood culture bottle types (aerobic vs anaerobic), blood culture systems (BD BACTEC FX vs BACT/ALERT VIRTUO), MALDI-TOF MS platforms (MALDI Biotyper sirius vs VITEK MS), lysis buffer volumes used in Sepsityper (standard vs half volume), and sample preparation methods for MALDI-TOF MS analysis (direct transfer, extended direct transfer, and full extraction) revealed no significant differences in identification rates. These findings suggest that the lysis buffer plays a critical role in the poor identification rate of S. pneumoniae using Sepsityper; however, halving its volume does not significantly improve the outcomes.IMPORTANCEThis study addresses a critical issue in clinical microbiology: the low identification rate of Streptococcus pneumoniae using the widely used Sepsityper for matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Accurate and timely identification of S. pneumoniae is essential for diagnosing invasive pneumococcal infections, which are associated with high morbidity and mortality rates. Our findings revealed that the lysis buffer in the Sepsityper significantly damaged the bacterial cell wall, leading to low identification rates for S. pneumoniae specifically. Replacing the lysis and washing buffers with a phosphate-buffered saline solution markedly improved the identification accuracy, offering a potential workaround. This study highlights the need for further refinement of diagnostic protocols for S. pneumoniae and underscores the importance of alternative enrichment methods to improve clinical outcomes. These findings have significant implications for laboratory and patient care worldwide.