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We assessed the accuracy of species-level identification of two commercially available matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) systems (Bruker Biotyper and Vitek MS) and two conventional phenotypic methods (Phoenix 100 YBC and Vitek 2 Yeast ID) with that of rDNA gene sequencing analysis among 200 clinical isolates of commonly encountered yeasts. The correct identification rates of the 200 yeast isolates to species or complex ( Candida parapsilosis  complex,  C. guilliermondii  complex and  C. rugosa  complex) levels by the Bruker Biotyper, Vitek MS (using in vitro devices [IVD] database), Phoenix 100 YBC and Vitek 2 Yeast ID (Sabouraud's dextrose agar) systems were 92.5%, 79.5%, 89%, and 74%, respectively. An additional 72 isolates of  C. parapsilosis  complex and 18 from the above 200 isolates (30 in each of  C. parapsilosis ,  C. metapsilosis , and  C. orthopsilosis ) were also evaluated separately. Bruker Biotyper system could accurately identify all  C. parapsilosis  complex to species level. Using Vitek 2 MS (IVD) system, all  C. parapsilosis  but none of  C. metapsilosis , or  C. orthopsilosis  could be accurately identified. Among the 89 yeasts misidentified by the Vitek 2 MS (IVD) system, 39 (43.8%), including 27  C. orthopsilosis  isolates, could be correctly identified Using the Vitek MS Plus SARAMIS database for research use only. This resulted in an increase in the rate of correct identification of all yeast isolates (87.5%) by Vitek 2 MS. The two species in  C. guilliermondii  complex ( C. guilliermondii  and  C. fermentati ) isolates were correctly identified by cluster analysis of spectra generated by the Bruker Biotyper system. Based on the results obtained in the current study, MALDI-TOF MS systems present a promising alternative for the routine identification of yeast species, including clinically commonly and rarely encountered yeast species and several species belonging to  C. parapsilosis  complex,  C. guilliermondii  complex, and  C. rugosa  complex.

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Comparison of the Accuracy of Two Conventional Phenotypic Methods and Two MALDI-TOF MS Systems with That of DNA Sequencing Analysis for Correctly Identifying Clinically Encountered Yeasts