Reduction in False-Positive Aspergillus Serum Galactomannan Enzyme Immunoassay Results Associated with Use of Piperacillin-Tazobactam in the United States

Vergidis, Paschalis; Razonable, Raymund R.; Wheat, L. Joseph; Estes, Lynn L.; Caliendo, Angela M.; Baden, Lindsey R.; Wingard, John R.; Baddley, John W.; Assi, Maha; Norris, Steven J.; Chandrasekar, Pranatharthi H.; Shields, Ryan K.; Nguyễn, Hồng Quân; Freifeld, Alison G.; Köhler, Richard; Kleiman, Martin B.; Walsh, Thomas J.; Hage, Chadi A.

doi:10.1128/jcm.00285-14

Cited by 56 publications

(37 citation statements)

References 11 publications

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“…Bronchoalveolar lavage galactomannan is more sensitive than serum GM in diagnosing probable or proven IA, likely due to a higher fungal burden in the airways than in the blood in IA, and increased secretion of GM in lung tissue . False positive BAL‐GM results occur in immunocompetent patients colonised with Aspergillus without clinical or radiographic evidence of IA, and potentially in patients receiving piperacillin‐tazobactam or gluconate‐containing solutions containing GM antigens; this is no longer a major concern due to changes in manufacturing . Occasionally, BAL‐GM may be positive in infections with other non‐ Aspergillus fungi .…”

Section: Introductionmentioning

confidence: 99%

False positive bronchoalveolar lavage galactomannan: Effect of host and cut‐off value

Farmakiotis

Weiss

et al. 2018

Mycoses

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Summary Objectives Bronchoalveolar lavage galactomannan (BAL‐GM) is a mycological criterion for diagnosis of probable invasive aspergillosis (IA) per European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORT‐MSG) consensus criteria, but its real‐world positive predictive value (PPV) has not been well‐studied. Our aim was to estimate the PPV of BAL‐GM in a contemporary cohort of patients with positive BAL‐GM. Methods We identified consecutive patients with ≥1 positive BAL‐GM value (index ≥ 0.5) at Brigham and Women's Hospital from 11/2009 to 3/2016. We classified patients as having no, possible, probable, or proven IA, excluding BAL‐GM as mycological criterion. Results We studied 134 patients: 54% had hematologic malignancy (HM), and 10% were solid organ transplant (SOT) recipients. A total of 42% of positive (≥0.5) BAL‐GM results were falsely positive (PPV 58%). The number of probable IA cases was increased by 23% using positive BAL‐GM as mycologic criterion alone. PPV was higher in patients with HM or SOT (P < 0.001) and with use of higher thresholds for positivity (BAL‐GM ≥ 1 vs 1‐0.8 vs 0.8‐0.5: P = 0.002). Conclusions 42% of positive BAL‐GM values were falsely positive. We propose a critical reassessment of BAL‐GM cutoff values in different patient populations. Accurate noninvasive tests for diagnosis of IA are urgently needed.

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Section: Introductionmentioning

confidence: 99%

False positive bronchoalveolar lavage galactomannan: Effect of host and cut‐off value

Farmakiotis

Weiss

et al. 2018

Mycoses

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“…These outcomes are constant with the inspection that antifungal therapy might bring down the fungal burden in the lung tissue (12,(18)(19)(20). However, due to crossreactivity between GM antigen and some antibiotics (21)(22)(23)(24)(25)(26)(27)(28) in patients who receive these antibiotics, the result of the GM assay may be controversial. Thus, additional specific 4 Jundishapur J Microbiol.…”

Section: Discussionmentioning

confidence: 99%

Investigating the Presence of Aspergillus fumigatus and A. flavus Using Galactomannan Enzyme Assay and TaqMan Real-Time PCR Technique

Roudbarmohammadi

Khorashad

Forouzandeh-Moghadam

et al. 2018

Jundishapur J Microbiol

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Background: Invasive aspergillosis (IA), a serious and fatal disease, is caused by numerous opportunistic fungi including Aspergillus species. Lack of early diagnosis and delay in treatment lead to the rapid spread of the infection and relapse, increase treatment costs, and ultimately cause death. Objectives: This study aimed at investigating the presence of Aspergillus species by Galactomannan EIA (GM) and TaqMan q PCR methods. Methods: Fluid samples of bronchoalveolar lavage (BAL) were collected from 89 patients, who were at risk for IA and underwent a bronchoscopy at Shariati hospital in Tehran, Iran. The specimens were examined using direct examination, culture methods, and GM and TaqMan real-time PCR. Results: A total of 23 samples were found to be positive in direct examination, 7 were identified as A. fumigatus, and 11 were positive as A.flavus in culture assays, 27 were GM positive, and 29 were positive with PAN Aspergillus probe. Moreover, 7 samples were positive with A. fumigatus probe and 11 were positive with A. flavus probe. Negative predictive value (NPV), sensitivity, positive predictive value

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“…(91–93) False positive serum GM tests have been reported in patients receiving certain formulations of piperacillin-tazobactam,(94) however subsequent studies suggest that current preparations of piperacillin-tazobactam do not generate cross-reactivity. (95)…”

Section: Diagnosticsmentioning

confidence: 99%

Pneumonia in the neutropenic cancer patient

Evans

Ost

2015

Current Opinion in Pulmonary Medicine

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Purpose of review Pneumonia is the leading cause of death among neutropenic cancer patients, particularly those with acute leukemia. Even with empiric therapy, case fatality rates of neutropenic pneumonias remain unacceptably high. However, recent advances in the management of neutropenic pneumonia offer hope for improved outcomes in the cancer setting. This review summarizes recent literature regarding the clinical presentation, microbiologic trends, diagnostic advances and therapeutic recommendations for cancer-related neutropenic pneumonia. Recent findings While neutropenic patients acquire pathogens both in community or nosocomial settings, patients’ obligate healthcare exposures result in the frequent identification of multidrug resistant bacterial organisms on conventional culture-based assessment of respiratory secretions. Modern molecular techniques, including expanded use of galactomannan testing, have further facilitated identification of fungal pathogens, allowing for aggressive interventions that appear to improve patient outcomes. Multiple interested societies have issued updated guidelines for antibiotic therapy of suspected neutropenic pneumonia. The benefit of antibiotic medications may be further enhanced by agents that promote host responses to infection. Summary Neutropenic cancer patients have numerous potential causes for pulmonary infiltrates and clinical deterioration, with lower respiratory tract infections among the most deadly. Early clinical suspicion, diagnosis and intervention for neutropenic pneumonia provide cancer patients’ best hope for survival.

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Reduction in False-Positive Aspergillus Serum Galactomannan Enzyme Immunoassay Results Associated with Use of Piperacillin-Tazobactam in the United States

Cited by 56 publications

References 11 publications

False positive bronchoalveolar lavage galactomannan: Effect of host and cut‐off value

False positive bronchoalveolar lavage galactomannan: Effect of host and cut‐off value

Investigating the Presence of Aspergillus fumigatus and A. flavus Using Galactomannan Enzyme Assay and TaqMan Real-Time PCR Technique

Pneumonia in the neutropenic cancer patient

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