Comparison of two MALDI-TOF MS platforms for identification of Trichosporon isolates from patients in a tertiary hospital in Hefei, China.

backgroundTrichosporon species are emerging opportunistic fungal pathogens associated with nosocomial infections, particularly in immunocompromised individuals. Accurate species identification and antifungal susceptibility testing are essential for appropriate clinical management. However, data on the distribution of Trichosporon species, the identification accuracy of matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF MS), and local epidemiological patterns in Hefei, China, remain limited.

methodsDemographic and clinical data from 99 patients corresponding to 164 Trichosporon isolates collected between June 2019 and December 2024 were retrospectively reviewed to assess epidemiological characteristics. A total of 68 isolates were further analyzed by intergenic spacer 1 (IGS1) sequencing, followed by phylogenetic analysis of the IGS1 region. Species identification was subsequently performed using two MALDI-TOF MS platforms: bioMérieux VITEK-MS and DL Smart MS 5020. Colony morphology was assessed after culture, and in vitro antifungal susceptibility profiles were determined.

resultsA total of 164 Trichosporon isolates from 99 patients were analyzed, with urine as the predominant specimen source (76.83%). Among 34 infected patients, urine remained the most common source (52.94%). These patients were predominantly male (70.59%), immunocompromised (73.53%), aged > 45 years (82.35%), and had undergone recent invasive procedures (82.35%). The median hospital stay was 36.5 days, suggesting that a substantial proportion of infections may have been nosocomial. Colony morphology varied with culture medium and incubation time and was insufficient for reliable species-level identification. Compared with IGS1 sequencing (n = 68), both MALDI-TOF MS platforms showed high genus-level accuracy; at the species level, performance was comparable for Trichosporon asahii (T. asahii) but diverged for Trichosporon asteroides (T. asteroides). Antifungal susceptibility testing revealed generally low minimum inhibitory concentrations (MICs) for amphotericin B (AMB) and triazoles.

conclusionTrichosporon isolates were mainly recovered from urine, particularly from male and immunocompromised patients. MALDI-TOF MS showed high accuracy at the genus level, whereas species-level discrepancies were observed, especially for closely related species such as T. asteroides. These findings suggest that confirmation by IGS1 sequencing, together with antifungal susceptibility testing, may improve species identification and support clinical management. CLINICAL TRIAL NUMBER: Not applicable.