Bruker Daltonics - Enhance clinical microbiology through mass spectrometry

This year, WHO dedicated half of its global focus list to infectious diseases, and while preventing the spread of bacteria is a clear priority, globalisation and antimicrobial resistance remain significant barriers to eradicating diseases such as tuberculosis.

Not only are highly evolved forms of bacteria spreading across borders, but the spread of broad spectrum antibiotics among humans and animals have made the bacteria resistant to certain forms of treatment.

For Dr Alexia Verroken, assistant laboratory leader at Saint-Luc University Clinic, gram-negative bacteria are now a significant threat, with these pathogens becoming increasingly resistant to advanced forms of antibiotics known as carbapenems.

"Carbapenems resistance is increasing in many European countries, and - in some areas - it's reaching endemic proportions," Verroken says. "We have to do everything we can in the microbiology laboratory to detect these strains as soon as possible, to treat the infections and stop them from being transmitted to other patients."

Identification is key

To address this problem, rapid and reliable detection methods have been developed, enabling biologists such as Verroken to identify the microorganism and quickly select optimal forms of treatment.

To this end, Saint-Luc University Clinic has been using the MALDI-TOF MS, developed by Bruker Daltonics, to quickly and precisely identify a range of gramnegative and gram-positive bacteria and yeasts.

Implemented in microbiology laboratories around the world, the IVD MALDI Biotyper System allows unbiased identification of microorganisms down to the species level, matching the protein structure of pathogens to an extensive library of approximately 3,000 organisms. This collection of microbes is consistently updated, and the device has an efficient and easy-to-use workflow, with samples transferred to the target plate where they are automatically matched against the reference library after MALDITOF spectra acquisition. Meanwhile, the laboratory is using Bruker's MBT Sepsityper IVD Kit in conjunction with the IVD MALDI Biotyper System to enhance the workflow and analyse blood samples faster, a measure that has been clinically proven to accelerate the turnaround time in traditional sampling methods by 48 hours.

"10 years ago you had to subculture the blood culture on the plates, wait 24 hours and then identify the microorganism," Verroken says. "The Sepsityper kit allows you to directly identify the bacteria from the positive blood culture within 15-20 minutes. We integrated the system in our lab about five years ago, and since then we've used the Sepsityper approach on a daily basis."

By combining the two approaches and accelerating the identification of positive blood cultures, physicians can work faster to manage blood stream infections such as Sepsis, fight against resistance and, ultimately, improve patient mortality rates.

Not only does this collaborative method identify pathogens in the bloodstream - enabling antibiotic treatments to be tailored to the patient - but the source of the infection can also be located.

"Certain bacteria can be found in urinary tract infections, or if you have Streptococcus pneumoniae the source could be a respiratory tract infection," Verroken says. "This guides the clinician towards the location of the infection, enabling them to do additional testing and control the source through additional surgery."

For Verroken, it is crucial that more microbiology laboratories implement these systems to enhance their working methods, allowing them to process blood samples quicker, and make precise estimations regarding the bacteria present and the microbial resistance they exhibit. Ultimately, in a high-pressure environment, where patient mortality rates are high, advanced diagnostic systems could be the difference between life and death. "In business, time is money," Verroken states. "But in a hospital, it can be life-saving."

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