Ann Lab Med 2017; 37(6): 475-483  
Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry in Clinical Microbiology: What Are the Current Issues?
Alex van Belkum, Ph.D.1, Martin Welker, Ph.D.1, David Pincus, Ph.D.1, Jean-Philippe Charrier, Ph.D.2, and Victoria Girard, Ph.D.1
Scientific Office1 and Innovation Department2, bioMérieux, La Balme Les Grottes, France
Correspondence to: Alex van Belkum
Scientific Office, bioMérieux, 3 Route de Port Michaud, La Balme Les Grottes 38390, France
Tel: +33-6-09487905 E-mail: alex.vanbelkum@biomerieux.com
Received: May 23, 2017; Revised: June 20, 2017; Accepted: July 25, 2017; Published online: November 1, 2017.
© The Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) has revolutionized the identification of microbial species in clinical microbiology laboratories. MALDI-TOF-MS has swiftly become the new gold-standard method owing to its key advantages of simplicity and robustness. However, as with all new methods, adoption of the MALDI-TOF MS approach is still not widespread. Optimal sample preparation has not yet been achieved for several applications, and there are continuing discussions on the need for improved database quality and the inclusion of additional microbial species. New applications such as in the field of antimicrobial susceptibility testing have been proposed but not yet translated to the level of ease and reproducibility that one should expect in routine diagnostic systems. Finally, during routine identification testing, unexpected results are regularly obtained, and the best methods for transmitting these results into clinical care are still evolving. We here discuss the success of MALDI-TOF MS in clinical microbiology and highlight fields of application that are still amenable to improvement.
Keywords: Mass Spectrometry, MALDI-TOF MS, Routine clinical microbiology, Taxonomy, Sample preparation, Antibiotic susceptibility testing, Future perspectives


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