A randomised controlled trial of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDITOF-MS) versus conventional microbiological methods for identifying pathogens: Impact on optimal antimicrobial therapy of invasive bacterial and fungal infections in Vietnam

Behzad Nadjm, Vu Quoc Dat, James I Campbell, Vu Tien Viet Dung, Alessandro Torre, Nguyen Thi Cam Tu, Ninh Thi Thanh Van, Dao Tuyet Trinh, Nguyen Phu Huong Lan, Nguyen Vu Trung, Nguyen Thi Thuy Hang, Le Thi Hoi, Stephen Baker, Marcel Wolbers, Nguyen Van Vinh Chau, Nguyen Van Kinh, Guy E Thwaites, H Rogier van Doorn, Heiman F L Wertheim, Behzad Nadjm, Vu Quoc Dat, James I Campbell, Vu Tien Viet Dung, Alessandro Torre, Nguyen Thi Cam Tu, Ninh Thi Thanh Van, Dao Tuyet Trinh, Nguyen Phu Huong Lan, Nguyen Vu Trung, Nguyen Thi Thuy Hang, Le Thi Hoi, Stephen Baker, Marcel Wolbers, Nguyen Van Vinh Chau, Nguyen Van Kinh, Guy E Thwaites, H Rogier van Doorn, Heiman F L Wertheim

Abstract

Objectives: We assessed the impact of MALDITOF-MS on the timeliness of optimal antimicrobial therapy through a parallel-arm randomised controlled trial in two hospitals in Vietnam.

Methods: We recruited patients with a pathogen (bacterial or fungal) cultured from a normally sterile sample. Samples were randomly assigned (1:1) to identification by MALDITOF-MS or conventional diagnostics. The primary outcome was the proportion on optimal antimicrobial therapy within 24 h of positive culture, determined by a blinded independent review committee. Trial registered at ClinicalTrials.gov (NCT02306330).

Results: Among 1005 randomised patients, pathogens were isolated from 628 (326 intervention, 302 control), with 377 excluded as likely contaminants or discharged/died before positive culture. Most isolates were cultured from blood (421/628, 67.0%). The proportion receiving optimal antimicrobial therapy within 24 h (the primary outcome) or 48 h of growth was not significantly different between MALDITOF-MS and control arms (135/326, 41.4% vs 120/302, 39.7%; Adjusted Odds ration (AOR) 1.17, p = 0.40 and 151/326, 46.3% vs 141/302, 46.7%; AOR 1.05 p = 0.79, respectively).

Conclusions: MALDITOF-MS, in the absence of an antimicrobial stewardship programme, did not improve the proportion on optimal antimicrobial therapy at 24 or 48 h after first growth in a lower-middle income setting with high rates of antibiotic resistance.

Keywords: Antibacterial agents; Bacteraemia; Matrix-assisted laser desorption-ionization mass spectrometry; Microbiological techniques; Vietnam.

Copyright © 2019. Published by Elsevier Ltd.

Figures

Fig. 1
Fig. 1
Trial flow. a2 patients randomised to MALDITOF had identification by routine methods. They were analysed as per their randomisation arm (i.e. included in MALDITOF group).
Fig. 2
Fig. 2
Time from growth to optimal antimicrobial therapy (OAT).

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Source: PubMed

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