Direct Matrix-assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry from Positive Blood Cultures: Feasibility and Need for Standardization in Indian Laboratories

Dear Editor, In today’s world of rising antimicrobial resistance (AMR), we must conduct rapid and accurate detection of pathogens, along with their antimicrobial susceptibility testing (AST).1 Therefore, we would like to highlight the underutilized direct pathogen detection method. Conventional methods are effective, but they take almost 48–72 h to provide identification and susceptibility. Rapid pathogen detection leads to targeted antimicrobial therapy, which ultimately helps in combating AMR. Direct matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) can be used for positively flagged automated blood culture bottles. This method of detection has a great potential to drastically improve the pathogen identification despite the instrument cost if we do proper standardization to guarantee its wider use to optimize its therapeutic value economically.2 MALDI-TOF-MS direct pathogen detection offers identification in <1 h. If followed by a direct AST method from blood broth, the time for susceptibility report can also be shortened, leading to rapid clinical decision-making and reduced turnaround time.3 In India, the widespread use and standardization of direct MALDI-TOF from positive blood culture bottles has significant therapeutic implications. India is facing challenges in implementing this technique due to high machinery cost, lack of protocol standardization, and uncertain result repeatability. Laboratory-based variability in ways of sample handling and preparation techniques makes comparing in different settings much more difficult.3 Developing and implementing a set standardized protocol will help overcome obstacles in direct MALDI-TOF-MS in blood culture. With the standard recommended guidelines, we can ensure the broader and more reliable adoption of this technique.4 There are different methods of performing direct MALDI-TOF from blood culture, and they have different advantages and disadvantages. Lysis centrifugation is more economical and good for low-resource settings, whereas the rapid filtration method is costly but gives us more rapid and reliable findings. There are other methods like distilled water or sodium dodecyl sulfate lysis, which are also economical and easy methods.5 High standards of practice can be maintained with the support of frequent accreditation and competence testing. By utilizing the existing facilities and resources, these techniques can be implemented in Indian laboratories at a reasonable cost. To ensure that laboratory staff members are proficient in these techniques. Furthermore, collaboration between clinical microbiologists, infectious disease specialists, and industrial partners is necessary to enhance and validate these methods. Rapid pathogen detection can result in more accurate antimicrobial stewardship, which can help fight AMR and lessen the misuse of broad-spectrum medicines. In addition, it can enhance patient outcomes by initiating targeted therapy, which lowers morbidity, mortality, and medical expenses.6 In a nutshell, the direct application of MALDI-TOF from automated blood culture bottles that have been labeled positive exhibits great potential; yet, its present underutilization in Indian settings highlights the necessity for standardization. We implore the scientific community, oversight organizations, and medical facilities to give top priority to the creation and application of uniform procedures for this method. By doing this, you can be sure that it will be adopted more widely and improve patient care in India in the long run. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.