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Mycology

Accuracy of Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry for Identification of Clinical Pathogenic Fungi: a Meta-Analysis

Huazhi Ling, Zhijie Yuan, Jilu Shen, Zhongxin Wang, Yuanhong Xu
D. W. Warnock, Editor
Huazhi Ling
aDepartment of Clinical Laboratory, First Affiliated Hospital, Anhui Medical University, Hefei, People's Republic of China
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Zhijie Yuan
bSchool of Mathematics, Hefei University of Technology, Hefei, People's Republic of China
cSchool of Electrical Engineering and Automation, Hefei University of Technology, Hefei, People's Republic of China
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Jilu Shen
aDepartment of Clinical Laboratory, First Affiliated Hospital, Anhui Medical University, Hefei, People's Republic of China
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Zhongxin Wang
aDepartment of Clinical Laboratory, First Affiliated Hospital, Anhui Medical University, Hefei, People's Republic of China
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Yuanhong Xu
aDepartment of Clinical Laboratory, First Affiliated Hospital, Anhui Medical University, Hefei, People's Republic of China
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D. W. Warnock
Roles: Editor
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DOI: 10.1128/JCM.00700-14
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ABSTRACT

Fungal infections in the clinic have become increasingly serious. In many cases, the identification of clinically relevant fungi remains time-consuming and may also be unreliable. Matrix-assisted laser desorption ionization–time of flight mass spectroscopy (MALDI-TOF MS) is a newly developed diagnostic tool that is increasingly being employed to rapidly and accurately identify clinical pathogenic microorganisms. The present meta-analysis aimed to systematically evaluate the accuracy of MALDI-TOF MS for the identification of clinical pathogenic fungi. After a rigorous selection process, 33 articles, involving 38 trials and a total of 9,977 fungal isolates, were included in the meta-analysis. The random-effects pooled identification accuracy of MALDI-TOF MS increased from 0.955 (95% confidence interval [CI], 0.939 to 0.969) at the species level to 0.977 (95% CI, 0.955 to 0.993) at the genus level (P < 0.001; χ2 = 15.452). Subgroup analyses were performed at the species level for several categories, including strain, source of strain, system, system database, and modified outcomes, to calculate the accuracy and to investigate heterogeneity. These analyses revealed significant differences between the overall meta-analysis and some of the subanalyses. In parallel, significant differences in heterogeneity among different systems and among different methods for calculating the identification ratios were found by multivariate metaregression, but none of the factors, except for the moderator of outcome, was significantly associated with heterogeneity by univariate metaregression. In summary, the MALDI-TOF MS method is highly accurate for the identification of clinically pathogenic fungi; future studies should analyze the comprehensive capability of this technology for clinical diagnostic microbiology.

FOOTNOTES

    • Received 10 March 2014.
    • Returned for modification 8 April 2014.
    • Accepted 5 May 2014.
    • Accepted manuscript posted online 14 May 2014.
  • Supplemental material for this article may be found at http://dx.doi.org/10.1128/JCM.00700-14.

  • Copyright © 2014, American Society for Microbiology. All Rights Reserved.
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Accuracy of Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry for Identification of Clinical Pathogenic Fungi: a Meta-Analysis
Huazhi Ling, Zhijie Yuan, Jilu Shen, Zhongxin Wang, Yuanhong Xu
Journal of Clinical Microbiology Jun 2014, 52 (7) 2573-2582; DOI: 10.1128/JCM.00700-14

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Accuracy of Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry for Identification of Clinical Pathogenic Fungi: a Meta-Analysis
Huazhi Ling, Zhijie Yuan, Jilu Shen, Zhongxin Wang, Yuanhong Xu
Journal of Clinical Microbiology Jun 2014, 52 (7) 2573-2582; DOI: 10.1128/JCM.00700-14
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