Vancomycin-resistant Enterococcus faecium represents a health threat due to its ability to spread and cause outbreaks. MALDI-TOF MS has demonstrated its usefulness for E. faecium identification, but its implementation for antimicrobial resistance detection is still under evaluation. This study assesses the repeatability of MALDI-TOF MS for peak analysis and its performance in the discrimination of vancomycin-susceptible (VSE) from vancomycin-resistant isolates (VRE). The study was carried out on protein spectra from 178 E. faecium unique clinical isolates—92 VSE, 31 VanA VRE, 55 VanB VRE-, processed with Clover MS Data Analysis software. Technical and biological repeatability were assayed. Unsupervised (principal component analysis, (PCA)) and supervised algorithms (support vector machine (SVM), random forest (RF) and partial least squares–discriminant analysis (PLS-DA)) were applied. The repeatability assay was performed with 18 peaks common to VSE and VRE with intensities above 1.0% of the maximum peak intensity. It showed lower variability for normalized data and for the peaks within the 3000–9000 m/z range. It was found that 80.9%, 79.2% and 77.5% VSE vs. VRE discrimination was achieved by applying SVM, RF and PLS-DA, respectively. Correct internal differentiation of VanA from VanB VRE isolates was obtained by SVM in 86.6% cases. The implementation of MALDI-TOF MS and peak analysis could represent a rapid and effective tool for VRE screening. However, further improvements are needed to increase the accuracy of this approach.

The goal of this study was to evaluate matrix-assisted laser desorption ionizationiime of flight mass spectrometry (MALDI-TOF MS) and Fourier-transform infrared spectroscopy (FTIR-S) as diagnostic alternatives to DNA-based methods for the detection of Pseudomonas aeruginosa sequence type (ST) 175 isolates involved in a hospital outbreak. For this purpose, 27 P. aeruginosa isolates from an outbreak detected in the Hematology department of our hospital were analyzed by the above-mentioned methodologies. Previously, these isolates had been characterized by pulse-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS). Besides, eight P. aeruginosa isolates were analyzed as unrelated controls. MALDI-TOF MS spectra were acquired by transferring several colonies onto the MALDI target and covering them with 1µl of formic acid 100 and 1µl of α-ciano-3,4-hidroxicinamic acid matrix. For the analysis with FTIR-S, colonies were resuspended in 70 ethanol and sterile water according to the manufacturers instructions. Spectra from both methodologies were analyzed using Clover Biosoft Software, which allowed data modeling using different algorithms and validation of the classifying models. Three outbreak-specific biomarkers were found at 5,169, 6,915, and 7,236m/z in MALDI-TOF MS spectra. Classification models based on these three biomarkers showed the same discrimination power displayed by PFGE. Besides, K-nearest neighbor algorithm allowed the discrimination of the same clusters provided by WGS and the validation of this model achieved 97.0 correct classification. On the other hand, FTIR-S showed a discrimination power similar to PFGE and reached correct discrimination of the different STs analyzed. In conclusion, the combination of both technologies evaluated, paired with machine learning tools, may represent a powerful tool for real-time monitoring of high-risk clones and isolates involved in nosocomial outbreaks.

The identification of filamentous fungi by matrix-assisted laser desorption/ionization–time of flight mass spectrometry (MALDI–TOF MS) represents a challenge due to their complex taxonomy and the lack of comprehensive databases. The aim of this study was to evaluate the current status of available MALDI–TOF MS databases for the identification of dermatophytes, including commercial, in-house, and web-based databases. We collected 289 dermatophyte strains from different centers and analyzed them using four databases and a combination of them. The combination of commercial and in-house databases was shown to improve the identification rate and accuracy at the species level. For Trichophyton rubrum, the concordance among all databases was above 90.0%. For the T. mentagrophytes group, correct identification at the species level ranged from 30.0 to 78.9%, depending on the database, and showed very low agreement among them. The addition of the novel species T. japonicum to our in-house database resulted in the successful identification of this species. On the other hand, T. interdigitale and T. tonsurans were the species most frequently misidentified by MALDI–TOF MS. Through deep spectra analysis of both species, up to 29 protein peaks were found to be suitable for their differentiation, demonstrating the potential of peak analysis in differentiating closely related species. In conclusion, improvements of the databases with new strains resulted in increased identification accuracy at the species level. This, combined with peak analysis, could improve the overall identification of dermatophytes by MALDI–TOF MS in clinical laboratories.

Clostridioides difficile is a major cause of hospital-acquired diarrhea, posing significant clinical challenges due to its high morbi-mortality rates and its involvement in nosocomial outbreaks. Detecting its toxigenic ribotypes rapidly and accurately is crucial for effective outbreak control. This study aimed to create a rapid diagnostic methodology based on MALDI-TOF MS and Machine Learning algorithms to differentiate toxigenic C. difficile RTs. MALDI-TOF spectra were acquired from 379 clinical isolates sourcing from 10 Spanish hospitals and analysed using Clover MSDAS, a specific software for MALDI-TOF spectra analysis, considered as the state-of-the-art tool for this purpose, and AutoCdiff, an ad hoc software developed in this study. Seven biomarker peaks were found to differentiate epidemic RT027 and RT181 strains from other RTs (2463, 3353, 4933, 4993, 6187, 6651 and 6710 m/z ). Two peaks (2463 and 4993 m/z ) were specifically found in RT027 isolates while combinations of the other 5 peaks allowed the differentiation of RT181 from other ribotypes. Automatic classification tools developed in Clover MSDAS and AutoCdiff using the specific peaks and the entire protein spectra, respectively, showed up to 100% balanced accuracy. Both methods allowed correct ribotype assignment for isolates sourcing from real-time outbreaks. The developed models, available from Clover MSDAS and the AutoCdiff website - https://bacteria.id-offer researchers a valuable tool for quick C. difficile ribotype determination based on MALDI-TOF spectra analysis. Although further validation of the models is still required, they represent rapid and cost-effective methods for standardized C. difficile ribotype assignment.

Vancomycin-resistant Enterococcus faecium has become a health threat over the last 20 years due to its ability to rapidly spread and cause outbreaks in hospital settings. Although MALDI-TOF MS has already demonstrated its usefulness for accurate identification of E. faecium , its implementation for antimicrobial resistance detection is still under evaluation. The reproducibility of MALDI-TOF MS for peak analysis and its performance for correct discrimination of vancomycin susceptible isolates (VSE) from those hosting the VanA and VanB resistance mechanisms was evaluated in this study. For the first goal, intra-spot, inter-spot -technical- and inter-day -biological- reproducibility was assayed. The capability of MALDI-TOF to discriminate VSE isolates from VanA VRE and VanB VRE strains was carried out on protein spectra from 178 E. faecium unique clinical isolates −92 VSE, 31 VanA VRE, 55 VanB VRE-, processed with Clover MS Data Analysis software. Unsupervised (Principal Component Analysis –PCA-) and supervised algorithms (Support Vector Machine -SVM-, Random Forest -RF- and Partial Least Squares-Discriminant Analysis -PLS-DA-) were applied. The reproducibility assay showed lower variability for normalized data (p<0.0001) and for the peaks within the 3000-9000 m/z range. Besides, 80.9%, 79.21% and 77.53% VSE vs VRE (VanA + VanB) discrimination was achieved by applying SVM, RF and PLS-DA, respectively. Correct differentiation of VanA from VanB VRE isolates was obtained by SVM in 86.65% cases. The implementation MALDI-TOF MS and peak analysis could represent a rapid and effective tool for VRE screening. However, further improvements are needed to increase the accuracy of this approach.