BACKGROUND:Non-tuberculosis mycobacteria (NTM) cause bloodstream and disseminated infections, for which early treatment initiation following accurate pathogen identification is critical. Rapid identification using MALDI-TOF MS and the PCR-reverse sequence-specific oligonucleotide (PCR-rSSO)-based mycobacteria detection panel are potentially useful. However, their direct application to NTM-positive blood cultures has not been evaluated. We aimed to assess the feasibility of applying these assays directly to blood culture broth without prior subculturing.
METHODS:Simulated blood culture broth samples with 10 NTM species-comprising type strains and clinical isolates-were prepared. Identification accuracy was assessed by comparison with the reference identifications based on type strains or whole-genome sequencing.
RESULTS:A total of 34 samples were prepared; Mycobacterium haemophilum was excluded because of identification-related quality issues, leaving 31 samples for analysis. MALDI-TOF MS showed 67.7% concordance with reference identifications (kappa coefficient, 0.64 [95% confidence interval (CI), 0.46-0.82]), with a higher concordance in rapidly growing mycobacteria (RGM) than in slowly growing mycobacteria (SGM). Concordance rates were 100% (kappa coefficient, 1.0) for RGM and 16.7% (kappa coefficient, 0.13 [95% CI, -0.03-0.29]) for SGM. Meanwhile, the PCR-rSSO panel achieved 87.1% overall agreement with the reference identifications (kappa coefficient, 0.86 [95% CI, 0.73-0.99] and enabled rapid detection of RGM and SGM, except for Mycobacterium mageritense, which was not covered by this panel.
CONCLUSION:MALDI-TOF MS provided accurate identification of RGM, whereas the PCR-rSSO panel demonstrated high identification performance for RGM and SGM. These methods are complementary; their combined utility warrants further evaluation in clinical settings.