This study was undertaken to evaluate matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for the rapid identification of beta-hemolytic streptococci. We compared Bruker Biotyper 2.0 with Vitek2 coupled to the agglutination test. MALDI-TOF MS analysis of 386 betahemolytic streptococcal isolates yielded high-confidence identification to the species level for all 386 isolates. The Vitek2 gave high-confidence identification to the species level for 88% of Streptococcus agalactiae isolates (n ؍ 269/306), 92% of Streptococcus pyogenes isolates (n ؍ 48/52), and 39% of isolates of Streptococcus dysgalactiae serogroups C and G (n ؍ 11/28).Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is a new technology for species identification based on the protein composition of microbial cells. Although the first descriptions of this method were published more than 10 years ago (5, 8), a wider use in routine microbiology laboratories became possible only recently when successful species identification for different genera was demonstrated (1,4,6,7,9,(11)(12)(13)(14). The most prominent advantages of the technology are speed and low cost (running cost), provided that a quality-controlled database of reference spectra, including all relevant microorganisms, is available. Substantial efforts have led to standardized sample preparation protocols (2), leading to improved reproducibility, databases, and analytical tools (10, 12). These new-generation methods are compared with state-of-the art sequence-based and conventional biochemical identifications in the present study.We evaluated the discriminative power of MALDI-TOF MS on 386 beta-hemolytic streptococcal isolates (306 isolates of Streptococcus agalactiae, 52 isolates of Streptococcus pyogenes, 10 isolates of Streptococcus dysgalactiae serogroup C, and 18 isolates of Streptococcus dysgalactiae serogroup G). Diagnostic accuracy was determined by comparing the MALDI-TOF MS system against conventional phenotypic characterization using the Gram Positive Identification Card (GP ID) of the Vitek2 system coupled to latex agglutination (Bio-Rad, Marnes-laCoquette, France).Samples originated from the following sources: gynecological swabs (n ϭ 260), urine (n ϭ 20), respiratory tract (n ϭ 50), wound and skin swabs (n ϭ 36), and blood cultures (n ϭ 20). All suspect isolates were subcultivated on sheep blood agar plates at 37°C with 5% CO 2 . After overnight growth, each sample was identified using the Gram Positive Identification card (GP ID) of the Vitek2 instrument coupled to latex agglutination to determine the Lancefield groups.Bruker Biotyper version 2.0 platform with library V.3.1.1.0 with 3,740 database entries was used for MALDI-TOF MS identification. MALDI target plates were inoculated by applying a small amount of a single freshly grown overnight colony directly onto a ground steel MALDI target plate in a thin film. The microbial film was then overlaid with 1.5 l of a MALDI matrix (a saturated ...