MALDI-TOF MS-Based Detection of Antimicrobial Resistance: Biomarkers, Assays and Clinical Applications – A Critical Review

Abstract The MALDI-TOF MS technique is now playing a major role in improving microbial diagnostics by enabling rapid and accurate identification of pathogens from minimal amounts of biological material. In recent years, its application has been extended to the detection of antimicrobial resistance trough diverse approaches (e.g., MALDIxin test, MBT-ASTRA, MBT-RESIST, FLAT or DOT-MGA). These strategies allow phenotypic assessment of resistance by measuring antibiotic degradation, identifying resistance-associated spectral peaks, or monitoring bacterial growth in the presence of antimicrobials, thereby providing clinically relevant results. This review critically discusses current evidence on MALDI-TOF MS-based detection of resistance to key antibiotic classes in major pathogens. It also highlights a typical performance metrics, antibiotic- and species-dependent variability, and focuses on remaining gaps in coverage of important resistance mechanism.