Background. Over the past decade, the World Health Organization has highlighted the need for rapid molecular diagnostics as first-line tools for detecting Mycobacterium tuberculosis complex (MTBC) to strengthen global tuberculosis control. At the same time, infections caused by non-tuberculous mycobacteria (NTM) have become increasingly prevalent, particularly in low TB-burden countries such as Italy. This changing epidemiological scenario underscores the necessity for fast and reliable methods capable of distinguishing NTM from MTBC, a critical step for guiding appropriate treatment. This study evaluated the diagnostic accuracy and potential applications of the STANDARD™ M10 MTB/NTM assay, which simultaneously detects and differentiates MTBC and NTM. Methods. A total of 155 clinical specimens (78.1% respiratory) from patients with suspected mycobacterial infection were tested by fluorescence microscopy, GeneXpert MTB/RIF Ultra (respiratory samples only), STANDARD™ M10 MTB/NTM and culture, used as the reference method. Results. Culture detected MTBC in 54% and NTM (predominantly slow-growing species) in 46% of samples. STANDARD™ M10 showed overall sensitivity and specificity of 70% and 100%, respectively. For MTBC, sensitivity was 85.1% with almost perfect agreement with culture (κ = 0.866), while for NTM, sensitivity was 50% with moderate agreement (κ = 0.566). Sensitivity decreased in microscopy-negative/culture-positive specimens, particularly for NTM. Compared with GeneXpert MTB/RIF Ultra, STANDARD™ M10 exhibited slightly lower sensitivity for MTBC but retained excellent specificity. Conclusions. STANDARD™ M10 MTB/NTM represents a rapid, fully automated tool to support early etiological diagnosis and MTB/NTM differentiation, mainly in selected samples or high-risk patients, but it does not replace culture or molecular tests providing species identification and MTBC drug-resistance profiling.

Background and Aims: patients suffering from systemic mycobacterial spread are at high risk of unfavorable clinical outcomes. Rapid microbiological diagnosis, however, is complicated due to the very slow cultural growth of mycobacteria. To facilitate the diagnostic workflow, we assessed a workflow allowing mass spectrometry-based identification and molecular resistance testing of mycobacteria directly from blood culture pellets. Materials and Methods: for this study, 50 blood cultures spiked with n=10 Mycobacterium tuberculosis (MTC) isolates and n=40 isolates belonging to 12 other species of non-tuberculous mycobacteria (n=13 M. abscessus complex, n=5 M. avium, n=3 M. chimaera, n=5 M. fortuitum, n=5 M. intracellulare, n=2 M. lentiflavum and n=2 M. mucogenicum, n=1 for each one of the species M. elephantis, M. hassiacum, M. marseillense, M. nebraskense and M. parascrofulaceum) were used next to two clinical cases of a disseminated infection in HIV patients. Results: the application of the MBT Sepsityper® kit allowed the correct species level identification by applying mass spectrometry as well as correct molecular resistance testing results as compared to the diagnostic reference approach applied with mycobacterial culture material. Conclusions: in conclusion, the results provide a proof-of-principle of the suitability of the assessed potential workflow in order to achieve a shortened time-to-result for the diagnosis of systemic mycobacterial infections. Future studies in high endemicity settings are desirable to assess the clinical applicability and impact of such a shortened workflow.