Dermatophytes are an important part of superficial fungal infections, and accurate diagnosis is paramount for successful treatment. Recently, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has emerged as a powerful tool to identify clinical pathogens; its advantages are cost-effectiveness, rapid detection, and high accuracy. However, as the accurate identification of clinical dermatophytes via MALDI-TOF MS has still not been fully evaluated, we performed a meta-analysis for its systematic evaluation. Fifteen eligible studies were involved and showed high accuracy with an identification ratio of 0.96 (95% CI = 0.92─1.01) and 0.91 (95% CI = 0.86─0.96) at the genus and species levels, respectively. The results showed higher accuracy ratio of Vitek MS (91%) than MALDI Biotyper (85%). Dermatophytes such as Trichophyton interdigitale (0.99, 95% CI = 0.97─1.02), T. mentagrophytes var interdigitale (1.00, 95% CI = 0.98─1.02), and Microsporum canis (0.97, 95% CI = 0.89─1.04) showed high accuracy in detected clinical dermatophytes. Moreover, a library with self-built database set up by laboratories showed higher accuracy than commercial database, and 15-day cultivation for dermatophytes showed highest accuracy considering culture time. High heterogeneity was observed and decreased only with the subgroup analysis of species. The subgroup analysis of mass spectrometry, library database, and culture time also exhibited high heterogeneity. In summary, our results showed that MALDI-TOF MS could be used for highly accurate detection of clinically pathogenic dermatophytes, which could be an alternative diagnostic method in addition to morphological and molecular methods.

中文翻译：

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基质辅助激光解吸电离-飞行时间质谱法测定临床皮肤癣菌的定性准确性：一项荟萃分析

皮肤癣菌是浅表真菌感染的重要组成部分，准确诊断对于成功治疗至关重要。最近，基质辅助激光解吸电离-飞行时间质谱（MALDI-TOF MS）已成为鉴定临床病原体的有力工具。其优点是性价比高、检测速度快、准确度高。然而，由于通过 MALDI-TOF MS 对临床皮肤癣菌的准确鉴定仍未得到充分评估，我们对其进行了系统评价的荟萃分析。共涉及 15 项符合条件的研究，在属和种水平上的识别率分别为 0.96（95% CI = 0.92─1.01）和 0.91（95% CI = 0.86─0.96）。结果显示，Vitek MS (91%) 的准确率高于 MALDI Biotyper (85%)。趾间毛癣菌 (0.99, 95% CI = 0.97─1.02)、趾间毛癣菌 (1.00, 95% CI = 0.98─1.02) 和犬小孢子菌 (0.97, 95% CI = 0.89─1.04) 等皮肤癣菌高检测到的临床皮肤癣菌的准确性。此外，实验室自建数据库的库比商业数据库显示出更高的准确性，15天的皮肤癣菌培养在考虑培养时间的情况下表现出最高的准确性。仅通过物种的亚组分析观察到高异质性并降低。质谱、图书馆数据库和培养时间的亚组分析也表现出高度异质性。总之，我们的结果表明，MALDI-TOF MS 可用于高度准确地检测临床致病性皮肤癣菌，