Official websites use. Share sensitive information only on official, secure websites. Address correspondence to Donna M. Wolk, dmwolk geisinger. Within the past decade, clinical microbiology laboratories experienced revolutionary changes in the way in which microorganisms are identified, moving away from slow, traditional microbial identification algorithms toward rapid molecular methods and mass spectrometry MS.
Historically, MS was clinically utilized as a high-complexity method adapted for protein-centered analysis of samples in chemistry and hematology laboratories. Today, matrix-assisted laser desorption ionization—time of flight MALDI-TOF MS is adapted for use in microbiology laboratories, where it serves as a paradigm-shifting, rapid, and robust method for accurate microbial identification.
Multiple instrument platforms, marketed by well-established manufacturers, are beginning to displace automated phenotypic identification instruments and in some cases genetic sequence-based identification practices. Finally, this review closes with a prospective view of the future of MALDI-TOF MS in the clinical microbiology laboratory to accelerate diagnosis and microbial identification to improve patient care.
Timely and accurate identification of microorganisms is the underlying function of any clinical microbiology laboratory and is accomplished through a consistently evolving repertoire of laboratory techniques. Historically, confirmation of microbial identification was dependent upon a hierarchy of assays separated into stages: i stain-based methodologies for classification of microscopic morphology to support early diagnostic and therapeutic decisions; ii microbial culture for propagation of the offending organism on agar or in liquid medium; iii biochemical or antigenic techniques for the subsequent metabolic and phenotypic analysis of the microorganism, ultimately leading to microbe identification; and iv antimicrobial susceptibility testing to confirm therapeutic choices or tailor therapy 1.
While historical sentiment among both microbiologists and clinicians accepted these established protocols as reference standards in terms of accuracy, speed, and costs , microbiologists, clinicians, and patients were at the mercy of the microorganism's growth rate.
