title: Assessing the risk of false positive serum galactomannan among patients receiving piperacillin/tazobactam for febrile neutropenia.
abstract: Galactomannan (GM) assay is commonly used as an early diagnostic tool for invasive fungal infection (IFI) in high-risk hematology patients. False positivity is frequently observed in GM with the use of piperacillin/tazobactam. The usage of generic drugs over the original brand has a significant cost advantage. The aim of this study was to assess the performance of GM test among patients receiving original and generic piperacillin/tazobactam formulations. The study included 85 adult patients; 62.4% were male with hematological malignancy currently receiving piperacillin/tazobactam. The study group was divided into two groups: patients receiving original and generic piperacillin/tazobactam. Serum GM index was positive in one of 35 patients receiving original piperacillin/tazobactam, whereas it was positive in 46 out of 50 patients receiving generic piperacillin/tazobactam (P < .001). However, the patients receiving generic piperacillin/tazobactam underwent computed tomography (CT) scans more frequently than those receiving original piperacillin/tazobactam (P = .047). In addition, in vitro analysis of GM was performed in two generics and one original piperacillin/tazobactam vials. One generic piperacillin/tazobactam vial included high GM level. False positivity of serum GM with generic formulations of piperacillin/tazobactam is still an ongoing issue in hematology patients. A high rate of serum GM index false positivity may unexpectedly lead to a higher rate of CT scan. Selected piperacillin/tazobactam vials in each batch should be checked for GM to identify a false positivity of GM before purchase.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology.
authors.forename: Hayati
authors.initials: H
authors.lastname: Demiraslan
authors.affiliation: Medical Microbiology.
authors.forename: M Altay
authors.initials: MA
authors.lastname: Atalay
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology.
authors.forename: Esma
authors.initials: E
authors.lastname: Eren
authors.affiliation: Hematology, Erciyes University, Kayseri, Turkey.
authors.forename: Koray
authors.initials: K
authors.lastname: Demir
authors.affiliation: Hematology, Erciyes University, Kayseri, Turkey.
authors.forename: Leylagul
authors.initials: L
authors.lastname: Kaynar
authors.affiliation: Medical Microbiology.
authors.forename: A Nedret
authors.initials: AN
authors.lastname: Koc
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Doganay
mesh_terms: D000900:Anti-Bacterial Agents / Q000592:standards / Q000627:therapeutic use*; D000946:Antigens, Fungal / Q000097:blood*; D005189:False Positive Reactions; D064147:Febrile Neutropenia / Q000150:complications* / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis; D008297:Male; D008351:Mannans / Q000097:blood*; D008828:Microbiological Techniques / Q000592:standards; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000592:standards / Q000627:therapeutic use; D010878:Piperacillin / Q000592:standards / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination
chemical_list: D000900:Anti-Bacterial Agents; D000946:Antigens, Fungal; D008351:Mannans; C012990:galactomannan; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin; D005690:Galactose
keywords: false positivity; febrile neutropenia; galactomannan test; generic formulations; piperacillin/tazobactam