2146. MALDI-TOF Mass Spectrometry Rapid Pathogen Identification and Outcomes of Patients with Bloodstream Infection: A Systematic Review and Meta-analysis

BACKGROUND: Several studies showed inconsistent results on the efficiency measures of the matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) technology and patients’ clinical outcomes. A meta-analysis was conducted to determine the effectiveness of MALDI-TOF MS-based bacteriology in improving the accuracy of microbiology report and clinical outcomes. METHODS: PubMed and EMBASE databases were searched from database inception through May 1, 2018 for pre–post and parallel comparative studies that evaluated the use of MALDI-TOF MS for identification of microorganism from blood culture. Pooled effect estimates were derived using the random-effects model. Univariate meta-regression on trial-level covariates was used to assess heterogeneity sources. Funnel plot, Begg’s and Egger’s tests were used to assess publication bias. RESULTS: Thirteen studies with 3,534 patients were meta-analyzed. Compared with conventional methods, MALDI-TOF MS was associated with 34% reduction in mortality (RR = 0.66; 95% CI: 0.54; 0.81; I(2) = 27.6%; 9 studies); 5.3-hour reduction in time-to-effective antibiotic therapy (95% CI: -6.4; -4.3; I(2) = 98.0%), 24.5-hour reduction in time to identify bacteria (95% CI: −25.7; −23.3; I(2) = 91.0%); 0.9-day reduction in hospital stay (95% CI: −1.4; −0.3; I(2) = 56.6%), and US$4100 saving in direct hospitalization cost (95% CI: $−8,200; $−113; I(2) = 66.1%). No significant heterogeneity sources were found (all P-interaction from meta-regression > 0.05) and no statistical evidence for publication bias was found (all P > 0.05). CONCLUSION: Rapid pathogen identification by MALDI-TOF MS with or without antibiotic stewardship was associated with reduced mortality, improved outcomes of bloodstream infection, and may be cost-effective among patients with bloodstream infection. Nevertheless, a multicenter randomized controlled trial is needed to confirm findings of these pre–post comparison studies. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.