[Investigation of Aspergillus galactomannan levels in antimicrobial agents].
The diagnosis of invasive aspergillosis which is a serious infection of immunocompromized patients, depends on the detection of Aspergillus galactomannan antigen in the serum by enzyme immunoassay (EIA) in routine laboratories. However, it has been previously reported that false positive results in Aspergillus galactomannan test may be obtained in the sera of patients sera receiving piperacillin-tazobactam (PIP-TAZ). The aim of this study was to investigate the presence and levels of Aspergillus galactomannan antigen in the content of PIP-TAZ and some other antimicrobial agents that are often used for the treatment of infections in immunocompromised patients. The level of galactomannan antigen was determined for PIP-TAZ, ampicillin-sulbactam, ampicillin, penicillin G, ceftriaxone, cefepime, imipenem, clarithromycin, ciprofloxacin, vancomycin, gentamicin, trimethoprim-sulfamethoxazole, ornidazole, fluconazole and amphotericin B, by a commercial EIA (Platelia Aspergillus EIA, Bio-Rad, France) kit. Galactomannan index (GI) was estimated with the ratio of absorbance values of antimicrobials to cut-off value and evaluated as positive when GI was found >0.5. Amongst the 15 antibiotics studied, the only positive result was detected for ampicillin with the highest index value (GI = 0.540), followed by PIP-TAZ with a relatively high value (GI = 0.235) even though it was not in the range of positivity. GI values have ranged from 0.011 to 0.188 for the other antibiotics. In conclusion, the use of especially ampicillin (and probably PIP-TAZ) therapy should be questioned in patients whose sera are being tested for Aspergillus galactomannan antigen by EIA in order to evaluate the positive results in terms of false positivities due to cross reactivity.
Yücesoy
Mine
M
Dokuz Eylül Universitesi Tip Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Izmir. mine.yucesoy@deu.edu.tr
Ergon
M Cem
MC
D000667:Ampicillin / Q000737:chemistry / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000737:chemistry* / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000032:analysis*; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy; D001230:Aspergillus / Q000737:chemistry / Q000276:immunology*; D003429:Cross Reactions; D004340:Drug Contamination; D005189:False Positive Reactions; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D007124:Immunoenzyme Techniques; D008351:Mannans / Q000032:analysis*; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000737:chemistry / Q000627:therapeutic use; D010878:Piperacillin / Q000737:chemistry / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination
D000900:Anti-Bacterial Agents; D000946:Antigens, Fungal; D008351:Mannans; C012990:galactomannan; D000077725:Piperacillin, Tazobactam Drug Combination; D000667:Ampicillin; D010397:Penicillanic Acid; D010878:Piperacillin; D005690:Galactose