TABLE 1.
Summary of studies comparing the clinical outcomes of patients with or without MALDI‐TOF
| Author (Location, Year) | Design | Setting and study population | Size | Intervention | Outcome definition and case ascertainment | Intervention period | Control period |
|---|---|---|---|---|---|---|---|
| Vlek (Netherlands, 2012) | Pre–post | Paediatric patients with BSI | 253 | MALDI‐TOF | Time to pathogen identification (h) | 16.4 | 45.2 |
| Time to optimal antibiotics (h) | 17.5 | 24 | |||||
| Huang (USA, 2013) | Pre–post | Patients with BSI | 501 | MALDI‐TOF with AST | Time to effective antibiotics (h) | 20.4 | 30.1 |
| Time to pathogen identification (h) | 55.9 | 84 | |||||
| 30‐day mortality (%) | 12.70 | 20.30 | |||||
| Hospital LOS (days) | 14.2 | 11.4 | |||||
| ICU LOS (days) | 8.3 | 14.9 | |||||
| Recurrent bacteraemia (%) | 2.00 | 5.90 | |||||
| Carreno (USA, 2016) | Pre–post | Patient with BSI | 219 | MALDI‐TOF and AST | Time to effective antibiotics (h) | 0.06 | 0.18 |
| Time to optimal antibiotics (h) | 0.12 | 0.3 | |||||
| Mortality (%) | 7.6 | 11.4 | |||||
| LOS hospital (days) | 10 | 9 | |||||
| LOS ICU (days) | 5 | 4 | |||||
| Clerc (Switzerland, 2013) | Prospective cohort | Patients with G‐BSI | 202 | MALDI‐TOF | Use of empiric antibiotics | 8.9% | 5.0% |
| Streamlining | 10.9% | 7.9% | |||||
| Spectrum broadening | 15.3% | 7.9% | |||||
| Delport (Canada, 2016) | Pre–post | Paediatric patients with BSI | 92 | MALDI‐TOF | Time to effective antibiotics (h) | 14.4 | 14.5 |
| Time to optimal antibiotics (h) | 78.33 | 68.8 | |||||
| Time to Gram stain result (h) | 27.2 | 29.4 | |||||
| Time to pathogen identification (h) | 75.7 | 87.2 | |||||
| Hospital LOS (h) | 508.8 | 582.5 | |||||
| Lockwood (USA, 2016) | Pre–post | Patients with G‐BSI | 346 | MALDI‐TOF and AST | Time to effective antibiotics (h) | 22 | 48 |
| Time to pathogen identification (h) | 6.5 | 32 | |||||
| 30‐day mortality (%) | 4.9 | 9.4 | |||||
| Time to optimal antibiotics (h) | 30 | 71 | |||||
| ICU LOS (days) | 3.7 | 2.3 | |||||
| Hospital LOS (days) | 6.4 | 6.4 | |||||
| Costs ($) | 22,473 | 24,116 | |||||
| Nagel (USA, 2014) | Pre–post | Patients with positive CoNS blood culture | 78 | MALDI‐TOF and AST | Time to effective antibiotics (h) | 23 | 37.7 |
| Time to optimal antibiotics (h) | 34.4 | 58.7 | |||||
| Time to pathogen identification (h) | 57 | 83.4 | |||||
| 30‐day mortality (%) | 3.1 | 21.7 | |||||
| ICU LOS (days) | 11 | 28 | |||||
| Hospital LOS (days) | 15 | 14 | |||||
| 30‐day readmission | 0 | 4.3 | |||||
| Recurrent bacteraemia (%) | 0 | 13 | |||||
| Osthoff (Switzerland, 2017) | Pre–post | Patients with BSI | 242 | MALDI‐TOF | Time to pathogen identification (h) | 28.2 | 49.7 |
| Duration of IV antibiotics (days) | 13.1 | 13.7 | |||||
| Duration of antibiotics (days) | 18.5 | 18.7 | |||||
| Hospital LOS (days) | 16.2 | 19 | |||||
| 30‐day mortality (%) | 8.3 | 16.5 | |||||
| In‐hospital mortality (%) | 7.4 | 12.4 | |||||
| Admission to ICU after BSI onset | 23.1 | 37.2 | |||||
| Perez (USA, 2013) | Pre–post | Patients with BSI | 219 | MALDI‐TOF | Time to effective antibiotics (h) | 24.4 | 47.1 |
| Time to optimal antibiotics (h) | 29 | 75 | |||||
| Time to pathogen identification (h) | 11.1 | 36.6 | |||||
| ICU LOS (days) | 4.9 | 6.1 | |||||
| Hospital LOS (days) | 8.1 | 9.9 | |||||
| Costs ($) | 26,162 | 45,709 | |||||
| Perez (USA, 2014) | Pre–post | Patients with antibiotic‐resistant G‐BSI | 269 | MALDI‐TOF | Time to effective antibiotics (h) | 29.3 | 46.7 |
| Time to optimal antibiotics (h) | 23.2 | 80.9 | |||||
| Time to pathogen identification (h) | 14.5 | 40.9 | |||||
| In‐hospital mortality (%) | 8 | 18.5 | |||||
| 30‐day mortality (%) | 8.9 | 21 | |||||
| 60‐day mortality (%) | 12.5 | 30.6 | |||||
| ICU LOS (days) | 7.3 | 12.5 | |||||
| Hospital LOS (days) | 10.8 | 16.2 | |||||
| Costs ($) | 52,693 | 78,991 | |||||
| Wenzler (USA, 2016) | Pre–post | Paediatric patients with A. baumannii pneumonia or BSI | 252 | MALDI‐TOF | Time to effective antibiotics (days) | 9 | 11 |
| 14‐day mortality (%) | 25 | 20 | |||||
| 30‐day readmission (%) | 8 | 9 | |||||
| Clinical cure at 7 days (%) | 34 | 15 | |||||
| Hospital LOS (days) | 11 | 13 | |||||
| Costs ($) | 42,872 | 49,402 | |||||
| Jeon (Korea, 2018) | Pre–post | Patients >18 y/o with positive blood cultures | 556 | MALDI‐TOF | ICU_LOS (days) | 14.7 | 16.8 |
| Time to pathogen identification (h) | 63.5 | 86.4 | |||||
| Time to effective therapy (h) | 23.2 | 27.4 | |||||
| 30‐day mortality (%) | 15.7 | 17.54 | |||||
| Recurrent bacteraemia (%) | 2.8 | 5.2 | |||||
| Niwa (Japan, 2019) | Pre–post | Patients with bloodstream infections and candida bloodstream infection | 366 | MALDI‐TOF | Time to pathogen identification (h) | 48.6 | 78.1 |
| Time to effective antibiotics (h) | 12.9 | 26.2 | |||||
| Time to optimal antibiotics (h) | 53.3 | 91.7 | |||||
| 30‐day mortality (%) | 5.4 | 9.4 | |||||
| Recurrent bacteraemia (%) | 5.1 | 5.5 | |||||
| Zadka (Israel, 2019) | Pre–Post | Patients with positive blood culture (bacteria only) | 4170 | MALDI‐TOF and AST | Hospital LOS (days) | 9.79 | 10.83 |
| In‐hospital mortality (%) | 18.3 | 20.9 | |||||
| Mok (Korea, 2019) | Pre–post | Patients with MDR bacteraemia | 187 | MALDI‐TOF | Time to pathogen identification (h) | 82.5 | 92.3 |
| Time to effective antibiotics (h) | 99.5 | 102.2 | |||||
| 28‐day mortality (%) | 35.6 | 40.2 | |||||
| Lo (Canada, 2020) | Retrospective cohort | Patients with Gram‐negative bacteraemia | 377 | MALDI‐TOF | Time to Gram stain result (h) | 18.42 | 20.29 |
| Time to pathogen identification (h) | 34.58 | 48.91 | |||||
| Time to appropriate prescription (h) | 50.34 | 66.71 | |||||
| Time to appropriate discontinuation (h) | 58.21 | 68.39 | |||||
| MacGowan (UK, 2020) | RCT | Adult patients with positive blood culture for bacteria or fungi | 5550 | MALDI‐TOF | Time to pathogen identification (h) | 38.5 | 55.2 |
| Time to effective antibiotics (h) | 24 | 13 | |||||
| Hospital LOS (d) | 15 | 15 | |||||
| 28‐day mortality (%) | 18.50 | 17.69 | |||||
| Dixon (UK, 2021) | RCT | Adult patients with positive blood culture for bacteria or fungi | 4486 | MALDI‐TOF | 28‐day mortality (%) | 20.57 | 17.69 |
| 28‐day cost (£) | 8139 | 8253 | |||||
| Puckett (USA, 2021) | Pre–Post | Patients aged 0–26y having a blood culture positive for monomicrobial organism | 131 | MALDI‐TOF and AST | Time to effective antibiotics (h) | 42.7 | 60.8 |
| Time to optimal antibiotics (h) | 53.2 | 72.9 | |||||
| Time to pathogen identification (h) | 35.4 | 42.3 | |||||
| Shimamoto (Japan, 2021) | Retrospective cohort | Patients with enterococcal BSI | 173 | MALDI‐TOF | Time from positive blood culture drawn to definitive antibiotic therapy (days) | 1 | 3 |
| Hospital LOS (days) | 19 | 16 | |||||
| Duration of antibiotic treatment | 11 | 11 | |||||
| 28‐day mortality (%) | 26.4 | 29.3 | |||||
| López‐Pintor (Spain, 2021) | Pre–post | Patients with positive blood cultures with GNB | 332 | MALDI‐TOF | Time from positive blood culture to antibiotic treatment (days) | 1.0 | 2.0 |
| 30‐day mortality (%) | 7.98 | 4.8 | |||||
| Hospital LOS (days) | 8 | 8 | |||||
| 30‐day readmission (%) | 15 | 10 |