새로운 MALDI-TOF 시스템 ASTA MicroIDSys를 이용한 Candida auris 및 연관 균종의 동정
Identification of Candida auris and Closely Related Species Using a New Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry, the ASTA MicroIDSys System
전남대학교 의과대학 진단검사의학교실1, 노스퀘스트 연구소2, 전북대학교 의과대학 진단검사의학교실3, 전남대학교 의과대학 기생충학교실4, 전남대학교 의과대학 미생물학교실5
Department of Laboratory Medicine1, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun; Research and Development Center of Nosquest Inc.2, Seongnam; Department of Laboratory Medicine3, Jeonbuk National University Medical School and Hospital, Jeonju; Department of Parasitology and Tropical Medicine4, Chonnam National University Medical School, Hwasun; Department of Microbiology5, Chonnam National University Medical School, Hwasun, KoreaCorrespondence to:
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Lab Med Online 2022; 12(1): 40-45
Published January 1, 2022
Copyright © The Korean Society for Laboratory Medicine.
A new matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)-based ASTA MicroIDSys system (ASTA Inc, Suwon, Korea; hereafter, ASTA) has been developed and is being used for the identification of clinically important pathogens in microbiology laboratories [1-4]. The current ASTA MicroIDSys database (coreDB ver 1.27; hereafter, AMDB) contains 428 yeast species but does not include a reference spectrum database of
The AMDB was expanded using 20 reference strains, including 15 strains from the U.S. Food and Drug Administration-Centers for Disease Control and Prevention (CDC) Antibiotic Resistance (AR) Isolate Bank (10 isolates from all four clades of
To compare the ASTA system after database expansion (coreDB v1.27.02) and the Biotyper system with library version 4.0, we tested a panel of molecularly identified
Table 1 shows the identification results and extraction methods for the two MALDI-TOF MS systems. Of the 91 isolates tested, 97.8% were correctly identified by the ASTA system to the species level after on-plate FA extraction and 95.6% were identified by the Biotyper system after in-tube FA/ACN extraction. The results indicated that the ASTA system has a comparable identification performance to the Biotyper system for isolates of
In-tube FA/ACN extraction generates best-quality mass spectra, but on-plate FA extraction is a simpler method that may be generally useful for clinical purposes . Only 79.1% (72/91) were correctly identified when we attempted to identify all isolates using the Biotyper system after on-plate FA extraction. Of the 19 isolates that were not correctly identified after on-plate FA extraction, only two isolates of
The recent emergence of
In a previous study, we showed that MLST analyses can differentiate
Figure 1. Heat map (A) and dendrogram (B) of mass spectrometry (MS) profiles generated by the ASTA system for 17 representative
C. aurisisolates (K1 to K17) from Korean hospitals and 20 internationally collected reference strains of C. aurisand closely related species used for database expansion of the ASTA system (AR0381–AR0395, KCTC 17806–17810). The isolation year, source, and MLST type of the Korean isolates (K1 to K17) are shown following the species name ( C. auris) of each isolate. (A) Columns show each strain of the species, rows indicate clustered m/z, and heat represents the degree of intensity. (B) The dendrogram is constructed by hierarchical clustering and is labeled with strain names. Strains were clustered by species, and strains of C. auriswere clustered into clade II and non-clade II groups.
In summary, here, we constructed an expanded clinical database for the ASTA system (coreDB v1.27.02) using 20 reference strains of
- Lee Y, Sung JY, Kim H, Yong D, Lee K. Comparison of a new matrix-assisted laser desorption/ionization time-of-flight mass spectrometry platform, ASTA MicroIDSys, with Bruker Biotyper for species identification. Ann Lab Med 2017;37:531-5.
- Lee H, Park JH, Oh J, Cho S, Koo J, Park IC, et al. Evaluation of a new matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system for the identification of yeast isolation. J Clin Lab Anal 2019;33:e22685.
- Kim D, Ji S, Kim JR, Kim M, Byun JH, Yum JH, et al. Performance evaluation of a new matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, ASTA MicroIDSys system, in bacterial identification against clinical isolates of anaerobic bacteria. Anaerobe 2020;61:102131.
- Jung J, Kim SY, Park YJ, Lee J, Suk HS, Ha SI, et al. Comparison of the ASTA MicroIDSys and VITEK MS matrix-assisted laser desorption/ionization time-of-flight mass spectrometry systems for identification of clinical bacteria and yeasts. J Infect Chemother 2020;26:1328-33.
- Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H.
Candida aurissp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol 2009;53:41-4.
- Kim MN, Shin JH, Sung H, Lee K, Kim EC, Ryoo N, et al.
Candida haemuloniiand closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features. Clin Infect Dis 2009;48:e57-61.
- Lee WG, Shin JH, Uh Y, Kang MG, Kim SH, Park KH, et al. First three reported cases of nosocomial fungemia caused by
Candida auris. J Clin Microbiol 2011;49:3139-42.
- Abastabar M, Haghani I, Ahangarkani F, Rezai MS, Taghizadeh Armaki M, Roodgari S, et al.
Candida aurisotomycosis in Iran and review of recent literature. Mycoses 2019;62:101-5.
- Gade L, Muñoz JF, Sheth M, Wagner D, Berkow EL, Forsberg K, et al. Understanding the emergence of multidrug-resistant
Candida: using whole-genome sequencing to describe the population structure of Candida haemuloniispecies complex. Front Genet 2020;11:554.
- Chow NA, de Groot T, Badali H, Abastabar M, Chiller TM, Meis JF. Potential fifth clade of
Candida auris, Iran, 2018. Emerg Infect Dis 2019;25:1780-1.
- Welsh RM, Sexton DJ, Forsberg K, Vallabhaneni S, Litvintseva A. Insights into the unique nature of the East Asian clade of the emerging pathogenic yeast
Candida auris. J Clin Microbiol 2019;57:e00007-19.
- Kwon YJ, Shin JH, Byun SA, Choi MJ, Won EJ, Lee D, et al.
Candida aurisclinical isolates from South Korea: identification, antifungal susceptibility, and genotyping. J Clin Microbiol 2019;57:e01624-18.
- Lima SL, Francisco EC, de Almeida Júnior JN, Santos DWCL, Carlesse F, Queiroz-Telles F, et al. Increasing prevalence of multidrug-resistant
Candida haemuloniispecies complex among all yeast cultures collected by a reference laboratory over the past 11 years. J Fungi (Basel) 2020;6:110.
- Lee HS, Shin JH, Choi MJ, Won EJ, Kee SJ, Kim SH, et al. Comparison of the Bruker Biotyper and VITEK MS matrix-assisted laser desorption/ionization time-of-flight mass spectrometry systems using a formic acid extraction method to identify common and uncommon yeast isolates. Ann Lab Med 2017;37:223-30.
- Pence MA, McElvania TeKippe E, Wallace MA, Burnham CA. Comparison and optimization of two MALDI-TOF MS platforms for the identification of medically relevant yeast species. Eur J Clin Microbiol Infect Dis 2014;33:1703-12.
- Cassagne C, Cella AL, Suchon P, Normand AC, Ranque S, Piarroux R. Evaluation of four pretreatment procedures for MALDI-TOF MS yeast identification in the routine clinical laboratory. Med Mycol 2013;51:371-7.
- Khot PD, Couturier MR, Wilson A, Croft A, Fisher MA. Optimization of matrix-assisted laser desorption ionization-time of flight mass spectrometry analysis for bacterial identification. J Clin Microbiol 2012;50:3845-52.
- Fraser M, Brown Z, Houldsworth M, Borman AM, Johnson EM. Rapid identification of 6328 isolates of pathogenic yeasts using MALDI-ToF MS and a simplified, rapid extraction procedure that is compatible with the Bruker Biotyper platform and database. Med Mycol 2016;54:80-8.
- Mizusawa M, Miller H, Green R, Lee R, Durante M, Perkins R, et al. Can multidrug-resistant
Candida aurisbe reliably identified in clinical microbiology laboratories? J Clin Microbiol 2017;55:638-40.
- Chow NA, Gade L, Tsay SV, Forsberg K, Greenko JA, Southwick KL, et al. Multiple introductions and subsequent transmission of multidrug-resistant
Candida aurisin the USA: a molecular epidemiological survey. Lancet Infect Dis 2018;18:1377-84.