Assessing the risk of false positive serum galactomannan among patients receiving piperacillin/tazobactam for febrile neutropenia

Demiraslan, Hayati; Atalay, M. Altay; Eren, Esma; Demir, Koray; Kaynar, Leylagül; Koç, Ayşe; Doğanay, Mehmet

doi:10.1093/mmy/myw129

Cited by 18 publications

(13 citation statements)

References 25 publications

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“…Aspergillus antigens are an important biomarker for the early diagnosis of invasive aspergillosis (IA) [42]. In their landmark study of 1979, Reiss and Lehmann [43] found that galactomannan (GM) antigen, a polysaccharide present in the cell wall of most Aspergillus species, is released from growing hyphae during infection.…”

Section: Aspergillosismentioning

confidence: 99%

Identification of Mycoses in Developing Countries

Arastehfar

Wickes

İlkit

et al. 2019

JoF

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Extensive advances in technology offer a vast variety of diagnostic methods that save time and costs, but identification of fungal species causing human infections remains challenging in developing countries. Since the echinocandins, antifungals widely used to treat invasive mycoses, are still unavailable in developing countries where a considerable number of problematic fungal species are present, rapid and reliable identification is of paramount importance. Unaffordability, large footprints, lack of skilled personnel, and high costs associated with maintenance and infrastructure are the main factors precluding the establishment of high-precision technologies that can replace inexpensive yet time-consuming and inaccurate phenotypic methods. In addition, point-of-care lateral flow assay tests are available for the diagnosis of Aspergillus and Cryptococcus and are highly relevant for developing countries. An Aspergillus galactomannan lateral flow assay is also now available. Real-time PCR remains difficult to standardize and is not widespread in countries with limited resources. Isothermal and conventional PCR-based amplification assays may be alternative solutions. The combination of real-time PCR and serological assays can significantly increase diagnostic efficiency. However, this approach is too expensive for medical institutions in developing countries. Further advances in next-generation sequencing and other innovative technologies such as clustered regularly interspaced short palindromic repeats (CRISPR)-based diagnostic tools may lead to efficient, alternate methods that can be used in point-of-care assays, which may supplement or replace some of the current technologies and improve the diagnostics of fungal infections in developing countries.

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Section: Aspergillosismentioning

confidence: 99%

Identification of Mycoses in Developing Countries

Arastehfar

Wickes

İlkit

et al. 2019

JoF

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“…The detection of galactomannans in serum and/or BAL of patients admitted during the case period (2,75%) and the control period (5,03%) did not show any statistically significant correlation between the presence of the renovation activities compared to the absence of these. The GM test is the most rapid detection method for IA diagnosis; nevertheless, false positive could be observed in patients simultaneously treated with piperacillin/tazobactam generic formula 33. Our study shows that for 2 patients the positivity to GM test was not confirmed by clinical and radiological data suggesting an alleged interference between antimicrobial agent and the GM detection assay.…”

Section: Discussionmentioning

confidence: 55%

Monitoring of Particle Environmental Pollution and Fungal Isolations During Hospital Building-Work Activities in a Hematology Ward.

Vincenti

Fiori

et al. 2019

Mediterr J Hematol Infect Dis

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Building-work activities could cause dust contamination and dissemination of fungal spores. Significant relationship was found between building-work activities and the incidence of invasive aspergillosis, in highly immunocompromised patients. Renovation-works activities were carried out by four building sites of the hematology ward in a Teaching Hospital without the interruption of clinical activities. These sites were monitored by environmental sampling to determine the particles and fungi count. Clinical surveillance were made using galactomannan antigen test as a proxy for invasive aspergillosis diagnosis. The galactomannan antigen test showed no significant difference between presence (3,85%) or absence (5,76%) of renovation work activities (p=0,497). The particle counts showed higher values of small and big-diameter particles before the renovation works if compared to the end of the activities. It was probably due to the containment measures implemented during and immediately after the final phases of the building site. The Fungi counts showed no particular differences between the phase before and after of the renovation activities. Our finding show that is possible to perform renovation work, during clinical activities, by increasing the clinical and the environmental surveillance.

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“…False positive GM antigenemia has been described before and was associated with the administration of generic piperacillin/tazobactam [18][19][20][21][22], hypercaloric drinks [23], antifungal prophylaxis [24,25], and even ice-pop ingestion and pasta. In most cases, the proposed mechanism for false positivity was the contamination of the product with GM.…”

Section: Discussionmentioning

confidence: 99%

Digestive enzymes of fungal origin as a relevant cause of false positive Aspergillus antigen testing in intensive care unit patients

et al. 2020

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Background Galactomannan antigen (GM) testing is widely used in the diagnosis of invasive aspergillosis (IA). Digestive enzymes play an important role in enzyme substitution therapy in exocrine pancreatic insufficiency. As digestive enzymes of fungal origin like Nortase contain enzymes from Aspergillus, a false-positive result of the test might be possible because of cross-reacting antigens of the cell wall of the producing fungi. We, therefore, asked whether the administration of fungal enzymes is a relevant cause of false-positive GM antigen test results. Methods Patients with a positive GM antigen test between January 2016 and April 2020 were included in the evaluation and divided into two groups: group 1-Nortase-therapy, group 2-no Nortase-therapy. In addition, dissolved Nortase samples were analyzed in vitro for GM and β-1,3-D-glucan. For statistical analysis, the chi-squared and Mann-Whitney U tests were used. Results Sixty-five patients were included in this evaluation (30 patients receiving Nortase and 35 patients not receiving Nortase). The overall false positivity rate of GM testing was 43.1%. Notably, false-positive results were detected significantly more often in the Nortase group (73.3%) than in the control group (17.1%, p < 0.001). While the positive predictive value of GM testing was 0.83 in the control group, there was a dramatic decline to 0.27 in the Nortase group. In vitro analysis proved that the Nortase enzyme preparation was highly positive for the fungal antigens GM and β-1,3-D-glucan. Conclusions Our data demonstrate that the administration of digestive enzymes of fungal origin like Nortase leads to a significantly higher rate of false-positive GM test results compared to that in patients without digestive enzyme treatment. Keywords Invasive aspergillosis • Critical illness • Galactomannan antigen assay • False positive results • Nortase • Digestive enzymes of fungal origin Abbreviations BAL Bronchoalveolar lavage BDG (1,3)-Beta-D-glucan CT Computed tomography DEFO Digestive enzymes of fungal origin ELISA Enzyme-linked immunosorbent assay GM Galactomannan IA Invasive aspergillosis ICU Intensive care unit PPV Positive predictive value

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Assessing the risk of false positive serum galactomannan among patients receiving piperacillin/tazobactam for febrile neutropenia

Cited by 18 publications

References 25 publications

Identification of Mycoses in Developing Countries

Identification of Mycoses in Developing Countries

Monitoring of Particle Environmental Pollution and Fungal Isolations During Hospital Building-Work Activities in a Hematology Ward.

Digestive enzymes of fungal origin as a relevant cause of false positive Aspergillus antigen testing in intensive care unit patients

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