Detection of Aspergillus Galactomannan Antigenemia To Determine Biological and Clinical Implications of Beta-Lactam Treatments

作者：Emmanuelle Bart–Delabesse, Maria Rosaria Basile, Ahmad Al Jijakli, Didier Souville, FREDERICK P. GAY, Bruno Philippe, Philippe Bossi, Martin Danis, Jean‐Paul Vernant, A. Datry · 发表于：Journal of Clinical Microbiology · 年份：2005 · DOI：10.1128/jcm.43.10.5214-5220.2005 · 被引用次数：75 · 研究领域：Antifungal resistance and susceptibility、Fungal Infections and Studies、Plant Pathogens and Fungal Diseases

ABSTRACT Detection of Aspergillus galactomannan (GM) in serum with the Platelia Aspergillus enzyme immunoassay (EIA) is useful for diagnosing invasive aspergillosis. From May 2003 to November 2004, 65 patients who did not develop aspergillosis had at least two positive sera while receiving a beta-lactam treatment (GM index [GMI], ≥0.5). Of the 69 treatment episodes scored, 41 consisted of a beta-lactam other than piperacillin-tazobactam ( n = 29), namely, amoxicillin-clavulanate ( n = 25), amoxicillin ( n = 10), ampicillin ( n = 3), or phenoxymethylpenicillin ( n = 2). In all cases, antigenemia became negative 24 h to 120 h upon stopping the antibiotic. Monitoring of 35 patients, including 26 with hematological malignancies, revealed three antigenemia kinetic patterns: each was observed with any drug regimen and consisted of a persistent GMI of >2.0 (65.7%), >0.5, and ≤1.5 (25.7%) or a variable GMI (14.3%) from the onset of antibiotic therapy. All available drug batches given to 26 patients cross-reacted with the EIA. Galactomannan titration in batches failed to predict the GM titers in the five patients studied at cumulative doses of ampicillin or amoxicillin-clavulanate, regardless of the time lapse between serum sampling and infusion period. Our results show that beta-lactams other than piperacillin-tazobactam may lead to false presumption of aspergillosis. The resulting kinetic patterns of GM antigenemia are variable, and sampling serum prior to the next beta-lactam dose ...