Knoll Miriam Alisa, Ulmer Hanno, Lass-Flörl Cornelia
Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, 6020 Innsbruck, Austria.
J Fungi (Basel). 2021 Jan 18;7(1):63. doi: 10.3390/jof7010063.
Due to the growing burden of fungal infections and a recent rise in antifungal resistance, antifungal susceptibility testing (AFST) is of increasing importance. The common methods of AFST have turnaround times of 24 to 48 h, and the available rapid methods are limited by applicability, cost-efficiency or accuracy. Given the urgency of adequate antifungal treatment in invasive mycoses, the need for the rapid and reliable detection of resistance is evident. In this systematic review and meta-analysis, we evaluated the diagnostic accuracy of AFST based on matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS). Twelve studies were reviewed, and data for the comparative analysis of their accuracy and methodology were systematically extracted. Compared to broth dilution as the gold standard, MALDI-TOF MS-based AFST reached a pooled sensitivity and specificity of 91% (95% Confidence Interval [CI], 84% to 96%) and 95% (95% CI, 90% to 98%), respectively. A comparative analysis showed that the sensitivity was higher for the semi-quantitative matrix-assisted laser desorption ionization Biotyper antibiotic susceptibility test rapid assay (MBT ASTRA) technique (96%) than for the correlate composite index (CCI) approach (85%), which is based on spectrum changes. Turnaround times below eight hours reached better diagnostic values than longer incubation periods, qualifying MALDI-TOF MS-based AFST as a rapid and accurate method for the detection of antifungal resistance.
由于真菌感染负担日益加重，且近期抗真菌耐药性有所上升，抗真菌药敏试验（AFST）的重要性日益凸显。AFST的常用方法周转时间为24至48小时，现有的快速方法在适用性、成本效益或准确性方面存在局限性。鉴于侵袭性真菌病进行充分抗真菌治疗的紧迫性，快速且可靠地检测耐药性的需求显而易见。在这项系统评价和荟萃分析中，我们评估了基于基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）的AFST的诊断准确性。我们回顾了12项研究，并系统提取了用于准确性和方法学比较分析的数据。与作为金标准的肉汤稀释法相比，基于MALDI-TOF MS的AFST的合并敏感性和特异性分别达到91%（95%置信区间[CI]，84%至96%）和95%（95%CI，90%至98%）。一项比较分析表明，半定量基质辅助激光解吸电离生物分型抗生素药敏试验快速检测法（MBT ASTRA）技术（96%）的敏感性高于基于光谱变化的相关复合指数（CCI）方法（85%）。与较长的孵育时间相比，8小时以内的周转时间具有更好的诊断价值，这使基于MALDI-TOF MS的AFST成为检测抗真菌耐药性的一种快速且准确的方法。
