Usefulness of MALDI-TOF Mass Spectrometry for Routine Identification of Candida Species in a Resource-Poor Setting Doudou Sow . Be ´caye Fall . Magatte Ndiaye . Bissoume Sambe Ba . Khadime Sylla . Roger Tine . Aminata Colle ´ Lo ˆ . Annie Abiola . Boubacar Wade . The ´re `se Dieng . Ye ´mou Dieng . Jean Louis Ndiaye . Christophe Hennequin . Oumar Gaye . Babacar Faye Received: 27 December 2014 / Accepted: 19 May 2015 Ó Springer Science+Business Media Dordrecht 2015 Abstract Background Identification of fungal clinical isolates is essential for therapeutic management. In resource- limited settings, identification mostly relies on bio- chemical tests whose sensitivity and specificity are known to be insufficient for identification of closely related or newly described species. MALDI-TOF has been shown in favored countries to be a reliable and powerful tool for microorganism identification, in- cluding yeasts. The aim of this study was to compare MALDI-TOF with routine identification procedures in a resource-poor context. Methods A total of 734 clinical specimens (502 vaginal swabs, 147 oral swabs, 61 bronchoalveolar lavage fluids and 24 stool samples) have been tested in the mycology unit of Fann Hospital, Dakar, Senegal. Strains isolated from culture were identified by both conventional phenotypic methods (germ tube formation and biochemical panels) and MALDI-TOF Saramis/ VITEK MS, bioMe ´rieux, France. In addition to com- paring the final identification, we determined the time of obtaining the results and the cost for both approaches. Results Overall, 218 (29.7 %) samples were positive for Candida. MALDI-TOF MS enabled the identifi- cation of 214 of the 218 strains isolated (98.1 %) at species level. Phenotypic approach yielded identifica- tion for 208 strains (95.4 %). Congruence between the tests was observed for 203 isolates. A discrepancy was observed for one isolate identified as Candida krusei with the phenotypic approach and Candida tropicalis with the MALDI-TOF. In addition, ten isolates identified at genus level by phenotypic methods were identified as C. glabrata (n = 8), C. tropicalis (n = 1) and C. parapsilosis (n = 1) by MALDI-TOF. The turnaround time for identification was \ 1 h using the MALDI-TOF compared to our routine procedures (48 h). The overall cost (reagents ? expendables) per isolate was at 1.35€ for the MALDI-TOF MS. Conclusion MALDI-TOF clearly outperformed the diagnosis capacities of phenotypic methods by reduc- ing the delay of results and giving accurate identifi- cation at species level. Moreover, this approach appears to be cost-effective and should be implement- ed especially in resource-poor context. Keywords MALDI-TOF MS Á Resource-limited settings Á Candida species Á Routine identification procedure D. Sow (&) Á M. Ndiaye Á K. Sylla Á R. Tine Á A. C. Lo ˆ Á A. Abiola Á T. Dieng Á Y. Dieng Á J. L. Ndiaye Á O. Gaye Á B. Faye Department of Parasitology, Faculty of Medicine, Universite ´ Cheikh Anta DIOP, Dakar, Senegal e-mail: doudsow@yahoo.fr B. Fall Á B. S. Ba Á B. Wade Service de Biologie, Ho ˆpital Principal de Dakar, Dakar, Senegal C. Hennequin Service de Parasitologie, Ho ˆpital Saint Antoine, Paris, France 123 Mycopathologia DOI 10.1007/s11046-015-9905-2