Impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) Coupled with Antimicrobial Stewardship Program on Pediatric ICU Patients in a Tertiary Care Pediatric Hospital

Yousef, Hamsah A.; Khairat, Sahar M.; Abdelhalim, Mona M.; Ishak, Sally K.I.; Ahmed, Elshimaa S.; Salem, Sherifa T.

doi:10.21608/ejmm.2025.351290.1430

Impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) Coupled with Antimicrobial Stewardship Program on Pediatric ICU Patients in a Tertiary Care Pediatric Hospital

Document Type : New and original researches in the field of Microbiology.

Authors

¹ Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University

² Department of Pediatrics, Faculty of Medicine, Cairo University

10.21608/ejmm.2025.351290.1430

Abstract

Background: Antimicrobial resistance (AMR) poses a significant global threat to public health and safety. To address this challenge, antimicrobial stewardship programs (ASPs) play an important role in optimizing antimicrobial use, reducing adverse effects, and lowering healthcare costs. Integrating advanced diagnostics like MALDI-TOF MS enhances ASP effectiveness, potentially improving antimicrobial use, lowering AMR rates, and bettering patient outcomes. Objective: This study aimed to evaluate the clinical impact of implementing MALDI‐TOF MS alongside ASP on the outcomes of PICU patients with various infections at Cairo University Specialized Pediatric Hospital (CUSPH). Method: A prospective cohort study was conducted in the PICUs at CUSPH. The 13-month study was divided into three phases: pre-implementation (baseline assessment), implementation (establishing guidelines and ASP orientation), and post-implementation. Key ASP indicators, such as length of stay, cure rate, mortality rate, length of therapy, and days of therapy, were measured. Results: In the post-implementation phase, both the average length of stay and mortality rate showed a notable decrease, with p-values of 0.059 and 0.06, respectively, suggesting a trend toward significance. The cure rate increased (p = 0.06). Additionally, the use of amphotericin significantly decreased (p = 0.03), while the use of cefepime (p = 0.002), clindamycin (p = 0.01), and linezolid (p = 0.03) increased. Klebsiella pneumoniae was the most isolated organism, accounting for 21% of cases. Conclusion: Integrating MALDI-TOF MS with ASP significantly reduce time to organism identification, improving time to optimal antibiotics therapy, with positive outcome measures including shortening hospital stays, increasing cure rate, and lowering mortality rates.

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