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Background  Nowadays, the global spread of resistance to oxyimino-cephalosporins in  Enterobacteriaceae  implies the need for novel diagnostics that can rapidly target resistant organisms from these bacterial species.    Methods  In this study, we developed and evaluated a Direct Mass Spectrometry assay for Beta-Lactamase (D-MSBL) that allows direct identification of (oxyimino)cephalosporin-resistant  Escherichia coli  or  Klebsiella pneumoniae  from positive blood cultures (BCs), by using the matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) technology.    Results  The D-MSBL assay was performed on 93  E .  coli  or  K .  pneumoniae  growing BC samples that were shortly co-incubated with cefotaxime (CTX) as the indicator cephalosporin. Susceptibility and resistance defining peaks from the samples’ mass spectra were analyzed by a novel algorithm for bacterial organism classification. The D-MSBL assay allowed discrimination between  E .  coli  and  K .  pneumoniae  that were resistant or susceptible to CTX with a sensitivity of 86.8% and a specificity of 98.2%.    Conclusion  The proposed algorithm-based D-MSBL assay, if integrated in the routine laboratory diagnostic workflow, may be useful to enhance the establishment of appropriate antibiotic therapy and to control the threat of oxyimino-cephalosporin resistance in hospital.

plos one

A rapid diagnostic workflow for cefotaxime-resistant Escherichia coli and Klebsiella pneumoniae detection from blood cultures by MALDI-TOF mass spectrometry