1. Blood Culture Broths Flag as &#8220;Positive&#8221;
<ol>
	<li>Remove the signaled blood culture bottle from the continuous monitoring incubation cabinet and place it into a biological safety cabinet. Note: Bottles can contain hazardous microorganisms and universal precautions need to be followed. Due to the risk of infectious aerosols in sampling, all sampling procedures must be performed in a Biosafety Class II laminar flow cabinet.</li>
</ol>
2. Gram Stain is Prepared
<ol>
	<li>Prepare a ...

<ol>
	<li>Bearman, G. M., Wenzel, R. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bacteremias:+a+leading+cause+of+death.">Bacteremias: a leading cause of death.</a> Arch. Med. Res. 36 (6), 646-659 (2005).</li><li>Leibovici, L., Shraga, I., Drucker, M., Konigsberger, H., Samra, Z., Pitlik, S. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+benefit+of+appropriate+empirical+antibiotic+treatment+in+patients+with+bloodstream+infection.">The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection.</a> J. Intern. Med. 244 (5), 379-386 (1998).</li><li>Kumar, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Duration+of+hypotension+before+initiation+of+effective+antimicrobial+therapy+is+the+critical+determinant+of+survival+in+human+septic+shock.">Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock.</a> Crit. Care Med. 34 (6), 1589-1596 (2006).</li><li>Munson, E. L., Diekema, D. J., Beekmann, S. E., Chapin, K. C., Doern, G. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+and+treatment+of+bloodstream+infection:+laboratory+reporting+and+antimicrobial+management.">Detection and treatment of bloodstream infection: laboratory reporting and antimicrobial management.</a> J. Clin. Microbiol. 41 (1), 495-497 (2003).</li><li>Clerc, O., Prod'hom, G., Vogne, C., Bizzini, A., Calandra, T., Greub, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+Matrix-Assisted+Laser+Desorption+Ionization+Time-of-Flight+Mass+Spectrometry+on+the+Clinical+Management+of+Patients+With+Gram-negative+Bacteremia:+A+Prospective+Observational+Study.">Impact of Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry on the Clinical Management of Patients With Gram-negative Bacteremia: A Prospective Observational Study.</a> Clin. Infect. Dis. 56 (8), 1101-1107 (2013).</li><li>Dekker, J. P., Branda, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> MALDI-TOF Mass Spectrometry in the Clinical Microbiology Laboratory. 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A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Utility+of+matrix-assisted+laser+desorption+ionization-time+of+flight+mass+spectrometry+following+introduction+for+routine+laboratory+bacterial+identification.">Utility of matrix-assisted laser desorption ionization-time of flight mass spectrometry following introduction for routine laboratory bacterial identification.</a> J. Clin. Microbiol. 49 (8), 2980-2984 (2011).</li><li>Schmidt, V., Jarosch, A., M&#228;rz, P., Sander, C., Vacata, V., Kalka-Moll, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rapid+identification+of+bacteria+in+positive+blood+culture+by+matrix-assisted+laser+desorption+ionization+time-of-flight+mass+spectrometry.">Rapid identification of bacteria in positive blood culture by matrix-assisted laser desorption ionization time-of-flight mass spectrometry.</a> Eur. J. Clin. Microbiol. Infect. Dis. 31 (3), 311-317 (2012).</li><li>March-Rossell&#243;, G. A., Mu&#241;oz-Moreno, M. F., de Urri&#233;s, M. C., Bratos-P&#233;rez, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+differential+centrifugation+protocol+and+validation+criterion+for+enhancing+mass+spectrometry+(MALDI-TOF)+results+in+microbial+identification+using+blood+culture+growth+bottles.">A differential centrifugation protocol and validation criterion for enhancing mass spectrometry (MALDI-TOF) results in microbial identification using blood culture growth bottles.</a> Eur. J. Clin. Microbiol. Infect. Dis. 32 (5), 699-704 (2012).</li><li>Christner, M., Rohde, H., Wolters, M., Sobottka, I., Wegscheider, K., Aepfelbacher, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rapid+identification+of+bacteria+from+positive+blood+culture+bottles+by+use+of+matrix-assisted+laser+desorption-ionization+time+of+flight+mass+spectrometry+fingerprinting.">Rapid identification of bacteria from positive blood culture bottles by use of matrix-assisted laser desorption-ionization time of flight mass spectrometry fingerprinting.</a> J. Clin. Microbiol. 48 (5), 1584-1591 (2010).</li><li>Gray, T. J., Thomas, L., Olma, T., Iredell, J. R., Chen, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rapid+identification+of+Gram-negative+organisms+from+blood+culture+bottles+using+a+modified+extraction+method+and+MALDI-TOF+mass+spectrometry.">Rapid identification of Gram-negative organisms from blood culture bottles using a modified extraction method and MALDI-TOF mass spectrometry.</a> Diagn. Microbiol. Infect. Dis. 72 (2), 110-112 (2013).</li><li>Hazelton, B. J., Thomas, L. C., Unver, T., Iredell, J. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rapid+identification+of+Gram-positive+pathogens+and+their+resistance+genes+from+positive+blood+culture+broth+using+a+multiplex+tandem+RT-PCR+assay.">Rapid identification of Gram-positive pathogens and their resistance genes from positive blood culture broth using a multiplex tandem RT-PCR assay.</a> J. Med. Microbiol. 62 (2), 223-2231 (2013).</li><li>Saffert, R. T., Cunningham, S. A., Mandrekar, J., Patel, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+three+preparatory+methods+for+detection+of+bacteremia+by+MALDI-TOF+mass+spectrometry.">Comparison of three preparatory methods for detection of bacteremia by MALDI-TOF mass spectrometry.</a> Diagn. Microbiol. Infect. Dis. 73 (1), 21-26 (2012).</li><li>Consoir, C., L&#246;rch, D., Schneider, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Direct+identification+of+bacteria+from+charcoal-containing+blood+culture+bottles+using+matrix-assisted+laser+desorption/ionisation+time-of-flight+mass+spectrometry.">Direct identification of bacteria from charcoal-containing blood culture bottles using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry.</a> Eur. J. Clin. Microbiol. Infect. Dis. 31 (10), 2843-2850 (2012).</li><li>Martiny, D., Dediste, A., Vandenberg, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+an+in-house+method+and+the+commercial+Sepsityper&#8482;+kit+for+bacterial+identification+directly+from+positive+blood+culture+broths+by+matrix-assisted+laser+desorption-ionisation+time-of-flight+mass+spectrometry.">Comparison of an in-house method and the commercial Sepsityper&#8482; kit for bacterial identification directly from positive blood culture broths by matrix-assisted laser desorption-ionisation time-of-flight mass spectrometry.</a> Eur. J. Clin. Microbiol. Infect. Dis. 31 (9), 2269-2281 (2012).</li><li>Moussaoui, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Matrix-assisted+laser+desorption+ionization+time-of-flight+mass+spectrometry+identifies+90%+of+bacteria+directly+from+blood+culture+vials.">Matrix-assisted laser desorption ionization time-of-flight mass spectrometry identifies 90% of bacteria directly from blood culture vials.</a> Clin Microbiol Infect. 16 (11), 1631-1638 (2010).</li><li>Novel, , et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=improved+sample+preparation+for+rapid,+direct+identification+from+positive+blood+cultures+using+matrix-assisted+laser+desorption/ionization+time-of-flight+(MALDI-TOF)+mass+spectrometry.">improved sample preparation for rapid, direct identification from positive blood cultures using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry.</a> J. Mol. Diagn. 13 (6), 701-706 (2011).</li><li>Fothergill, A., Kasinathan, V., Hyman, J., Walsh, J., Drake, T., Wang, Y. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rapid+Identification+of+Bacteria+and+Yeasts+from+Positive-Blood-Culture+Bottles+by+Using+a+Lysis-Filtration+Method+and+Matrix-Assisted+Laser+Desorption+Ionization-Time+of+Flight+Mass+Spectrum+Analysis+with+the+SARAMIS+Database.">Rapid Identification of Bacteria and Yeasts from Positive-Blood-Culture Bottles by Using a Lysis-Filtration Method and Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrum Analysis with the SARAMIS Database.</a> J. Clin. Microbiol. 51 (3), 805-809 (2013).</li></ol>

It is important when applying MALDI-TOF MS to blood culture broth that the post centrifugation steps are performed with sufficient care not to remix the separated components. It is particularly important to remove the blood culture constituents and human cellular proteins, including hemoglobin, which may produce spikes interfering with the MALDI-TOF spectra.
Although MS manufactures recommend cut of score of &#8805;2.0 for species and &#8805;1.7 for genus identification, other reports have sug...

Patients with bloodstream infection (BSI) due to bacteria continue to have high in-hospital mortality, ranging from 6-48%1. The delivery of appropriate empiric antibiotic promotes survival and in the subset of patients with severe sepsis, each hour delay to appropriate therapy correlates to decreased survival2,3. Accordingly, a key objective of the clinical laboratory is to rapidly detect, identify and communicate the presence of bacteria in blood cultures to inform clinical decisions. It has been demonstrated that the microbiology laboratory has the greatest influence on antimicrobial therapy at the time of reporting the Gram stain4 and recently, an observational study demonstrated that matrix-assisted laser desorption/ionization time of flight mass spectrometry&#160;(MALDI-TOF MS) performed directly on blood culture broths influence prescribing in over one third of BSI caused by Gram negative bacteria5.
The commercial development of MALDI-TOF MS has led to an efficacious laboratory tool for the identification of microorganisms6,7. The technology is now well established and has been integrated into many laboratories for rapid and accurate identification of microorganisms isolated on solid media6,8. The direct application of MALDI-TOF MS to blood culture (BC) broth that have signaled &#8220;positive&#8221; for microorganisms appeals to both clinicians and laboratory managers because of the potential to obtain an earlier identification of microorganisms at low cost.
The clinical utility of direct application of MALDI-TOF MS to blood culture broth has been limited by the wide range of sensitivities observed when compared with standard phenotypic culture based methods of identification, with reports of successful identification of Gram negative bacteria ranging from 47-98.9%9-11. The variation in sensitivity likely relates to the BC broth composition, initial bacterial concentration, variation in sample preparation methods as well as the array of Gram negative organisms encountered in study populations9. Compared with these other published protocols the method presented here avoids the use of ethanol, ammonium chloride or additional (non-matrix) acetonitrile. As a result the bacterial pellet will remain viable (until the point of protein extraction) allowing for potential phenotypic susceptibility testing methods to be applied directly to these organisms in broth. In addition, the presented method has been shown to be inexpensive, reliable and rapid with bacterial identification available within 25 min of the blood culture Gram stain results, with minimal &#8216;hands on&#8217; time12.
This method is a simple in-house spin-lysis protocol utilizing formic acid extraction applied directly to positive blood culture broths to identify Gram negative bacteria with MALDI-TOF MS technology.

<table border="0" cellpadding="0" cellspacing="0" width="1319">
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:275px;">BACTEC Plus Aerobic/F Medium</td>
			<td style="width:307px;">Becton Dickinson; BD, Franklin Lakes, NJ, USA</td>
			<td align="right" style="width:188px;">442192</td>
			<td style="width:551px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">BACTEC Lytic/10 Anaerobic /F Medium</td>
			<td>Becton Dickinson; BD, Franklin Lakes, NJ, USA</td>
			<td align="right">442265</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">BACTEC Peds Plus Medium</td>
			<td>Becton Dickinson; BD, Franklin Lakes, NJ, USA</td>
			<td align="right">442194</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Vacutainer - Blood transfer device</td>
			<td>Becton Dickinson; BD, Franklin Lakes, NJ, USA</td>
			<td align="right">364880</td>
			<td>Single use sampling device reducing the risk of needlestick injury</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Vacutainer SST 5.0mL, Advance plus</td>
			<td>Becton Dickinson; BD, Franklin Lakes, NJ, USA</td>
			<td align="right">367954</td>
			<td>Serum separating tube</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Syringe 10 mL</td>
			<td>Becton Dickinson; BD, Franklin Lakes, NJ, USA</td>
			<td align="right">302143</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Transfer pipette</td>
			<td>Samco, USA</td>
			<td>222-20S</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Transfer pipette (fine tipped)</td>
			<td>Samco, USA</td>
			<td>232-20S</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Microcentrifuge tube (2.0 mL)</td>
			<td>Eppendorf, Hamburg, Germany</td>
			<td>0030.120.094</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Sterile water (DNAse and RNAse free)</td>
			<td>Life Technologies, Carlsbad, California, USA</td>
			<td>10977-015</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Formic acid</td>
			<td>Sigma-Aldrich, St. Louis, Missouri, USA</td>
			<td>F0507</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Matrix solution&#160;</td>
			<td>Bruker Daltonics, Bremen Germany</td>
			<td align="right">285074</td>
			<td>10 mg/ml &#945;-cyano-4-hydroxycinnamic acid, 50% acetonitrile, 2.5% trifluoroacetic acid</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Benchtop microflex LT MALDI-TOF MS</td>
			<td>Bruker Daltonics, Bremen Germany</td>
			<td></td>
			<td>Utilizing BioTyper 3.1 (Build 65) and FlexControl 3.3 (Build 99) software</td>
		</tr>
	</tbody>
</table>

rapid identification of gram negative bacteria from blood culture broth using maldi-tof mass spectrometry

An important role of the clinical microbiology laboratory is to provide rapid identification of bacteria causing bloodstream infection. Traditional identification requires the sub-culture of signaled blood culture broth with identification available only after colonies on solid agar have matured. MALDI-TOF MS is a reliable, rapid method for identification of the majority of clinically relevant bacteria when applied to colonies on solid media. The application of MALDI-TOF MS directly to blood culture broth is an attractive approach as it has potential to accelerate species identification of bacteria and improve clinical management. However, an important problem to overcome is the pre-analysis removal of interfering resins, proteins and hemoglobin&#160;contained in blood culture specimens which, if not removed, interfere with the MS spectra and can result in insufficient or low discrimination identification scores. In addition it is necessary to concentrate bacteria to develop spectra of sufficient quality. The presented method describes the concentration, purification, and extraction of Gram negative bacteria allowing for the early identification of bacteria from a signaled blood culture broth.

The generated MALDI-TOF MS spectra are compared to the integrated reference database of spectra. A logarithmic score is assigned for the confidence of the match between the test isolate and the reference database isolates, with the recommendation of a score &#8805;1.7 required for probable identification to genera level (Figure 1)&#160;and &#8805;2.0 for probable identification to species (Figure 2).&#160;Report to species level when the score &#8805;1.7 and the first 5 identifications m...

Watch this Scientific Journal Video about Rapid Identification of Gram Negative Bacteria from Blood Culture Broth Using MALDI-TOF Mass Spectrometry at JoVE.com

Rapid Identification of Gram Negative Bacteria from Blood Culture Broth Using MALDI-TOF Mass Spectrometry

The application of matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry (MS) directly to blood culture broth expedites the identification of bacteria. The presented method is a rapid and reliable method for identification of Gram negative bacteria directly from blood culture broth.

An important role of the clinical microbiology laboratory is to provide rapid identification of bacteria causing bloodstream infection. Traditional ...

rapid-identification-gram-negative-bacteria-from-blood-culture-broth

Research

JoVE Journal

Immunology and Infection

23.8K ビュー.  Westmead Hospital. 直接血培養液への航空券のマトリックス支援レーザー脱離/イオン化時間（MALDI-TOF）質量分析（MS）の適用は、細菌の同定を促進。提示した方法は、血液培養ブロスから直接、グラム陰性細菌の同定のための迅速かつ信頼できる方法である。 