Until recently, bacterial identification in clinical laboratories has been mainly relying on conventional phenotypic and gene sequencing identification techniques. The identification of anaerobic bacteria is still fastidious due to slow bacteria growing. Many anaerobes are difficult in most diagnostic systems. For example, 12 weeks are needed for a clear diagnosis of active tuberculosis. This very long-time frame are really challenging for case identification. However, the last decade has seen the introduction of mass spectrometry into clinics for bacteria biotyping (1, 2, 3, 4). Bacterial typing by MS is based on the fingerprinting of bacteria ribosomal proteins profiles using Matrix-Assisted Laser Desorption Ionization (MALDI) Mass Spectrometry (MS) through interrogation of a database of reference profiles (5, 6). The technology was shown to be highly efficient after several inter-laboratory cross-validation(7) and MALDI MS biotyping has become a conventional method for hospital routine biotyping due to its speed, simple handling, cost-effectiveness and high-throughput capabilities(8). The U.S. Food and Drug Administration (FDA) has approved the MALDI Biotyper (Bruker) and the VITEK MS (Biomerieux) (9) bacterial biotyping systems for diagnostic purposes at the Hospital. However, yet some limitations exist in the method. Since the method is based on profiling the most abundant proteins which are constantly expressed (10), the identification rates using clinical isolates are reported to be 79.9% to 93.6% at the species level and 94.5% to 97.2% at the genus level (11, 12). Moreover, some treatment are needed in order to reduce some interferences from blood culture, and bacteria extracts are therefore treated with solvent such as 70% formic acid to extract some molecules out for MALDI‐TOF analysis (13). Lower confidence scores sometimes were observed due to occasional polymicrobial samples or lower bacteria number collected from the blood culture, yet MS based method is certainly faster than usual cultured‐based approach (13). Thus, MALDI-TOF MS biotyping systems have paved the way to a change of paradigm in bacteria typing. However, higher accuracy, confidence and convenience is still searched for. In this context, ambient ionization mass spectrometry (AIMS) techniques could represent an interesting alternative because of the limited sample preparation requested using such ambient methods are recently introduced in this field (14). Rapid Evaporative Ionisation Mass Spectrometry (REIMS) has been shown to provide a high-throughput platform for the rapid and accurate identification of bacterial and fungal isolates (15). In comparison to MALDI MS commercial systems, REIMS require no preparative steps nor time-consuming cell extractions (15). Species classification accuracy was found ranged between 96%-100% (16).
In this context, we performed human microorganism’s bio-typing with a novel ambient ionization mass spectrometer; the Spidermass instrument. The technology is based on Remote Infrared Matrix-Assisted Laser Desorption/Ionization (Remote IR-MALDI) system using tissue endogenous water as matrix (17-19)and was shown to enable in-vivo real-time mass spectrometry analysis with minimal invasiveness in intra-operative conditions during surgery or on ex vivo tissue resection (20).
Gram negative
The basic design of the instrument setup is already described in a previous study (17, 22). In these experiments, the prototype was equipped with a fibered tunable InfraRed Optical parametric oscillator (OPO) system between 2.8 μm to 3.1 μm (Radiant version 1.0.1, OPOTEK Inc., Carlsbad, USA) pumped by a 1.064 μm radiation delivered by a Q-switched 10 ns pulse width Nd:YAG laser (Quantel Laser, Les Ulis, France). A 1 meter length biocompatible laser fiber with 450 μm inner diameter (HP fiber, Infrared Fiber Systems, Silver Spring, USA) was connected to the exit of the OPO system and focused by a 20 mm focal length CaF2 lens attached at its end. A Tygon® ND 100-65 tubing (2.4 mm inner diameter, 4 mm inner diameter, Akron, USA) was used to aspirate the ablated material and was directly connected to the inlet of the mass spectrometer (Synapt G2s, Waters, Manchester) through a modified atmospheric pressure interface described elsewhere (18) (
Special care was taken when working with infrared laser beams. The laser used for this study is classified as safety class IV which requires the wear of specific laser safety goggles throughout all experiments. The samples were irradiated over 5 sec at 1.6 J/cm2. Only when the wavelength was tuned the fluence was decreased to 0.8 J/cm2 to allow for keeping it constant over the screened range. Three sample spots were deposited onto a glass slide to obtain significant results. The spectra acquisition were performed in positive resolution mode with a scan time of 0.5 sec.
For real time analysis, the built model was exported to a second software module called OMB Recognition. The parameters for this analysis were: a TIC threshold of 1E+4 count for irradiation detection, a normalized intensity threshold of 1E+6, and an outlier limit of 5 standard deviations. The software analyzes 1 scan per spectrum and has a 3s timeout waiting for good spectrum. The cross-validated models are exported from the OMB software and then loaded in the OMB Recognition software module before any real time piece of tissue analysis by the SpiderMass (18, 20). The real time acquired data are then directly interrogated, giving an immediate feedback using a color scale predefined from the specified classes.
m/z intervals corresponding to loadings with the largest contribution to the explained variance observed in the different groups were selected for MS/MS-based identification. For these experiments, the settings were exactly the same as described in the Instrumentation section and published (18, 20). The identifications were performed directly on the tissue by doing a full scan first to verify the presence of the targeted masses. Then after switching to MS/MS mode, they were subjected to collision-induced dissociation (CID) in the transfer cell with respectively 20 and 35 V. The resulting spectra were annotated manually, and assignments were verified by interrogating the high accuracy mass measurements of the precursor ions using the LipidsMap database.
To assess the performance of SpiderMass for biotyping, we studied two different of sampling and analytical conditions instrument (
compared tests performed on culture medium directly, agarose (petri dish) and on smears on glass slides for bacteria collected at T24 (
The next step consisted to perform biotyping on different species of Gram negative (
of m/z 719.35 to PG (16:0/16:1) and m/z 733.36 to PG (16:0/cys17:0), 773.38 to PG (18:1/18:1) (
We performed human pathogens bio-typing microorganisms using SpiderMass instrument in real time. In this context, we established that the most robust procedure based on smears of bacteria on glass slides. We then biotype human pathogens and observed the ability to distinguish Gram –; Gram + and yeast using SpiderMass technology based on their metabolites and lipids signatures. It is interesting to note, that specific bacteria signature can be detect at 4 hours growth in negative mode whereas other bio-typing technologies need at least 24hours culture growth and protein extraction procedures. Using SpiderMass same types of information is now given from 4 hours culture without any treatment. Taken together, we established that SpiderMass can be a useful instrument for bacteria biotyping in the clinical context and open the door of on tissue bacteria biotyping as well as in liquid for detecting Multi-resistant bacteria.