Yücesoy Mine, Ergon M Cem
Dokuz Eylül Universitesi Tip Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Izmir.
Mikrobiyol Bul. 2007 Oct;41(4):565-70.
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.
侵袭性曲霉病是免疫功能低下患者的一种严重感染，其诊断依赖于常规实验室通过酶免疫测定（EIA）检测血清中的曲霉半乳甘露聚糖抗原。然而，此前有报道称，接受哌拉西林 - 他唑巴坦（PIP - TAZ）治疗的患者血清中，曲霉半乳甘露聚糖检测可能会出现假阳性结果。本研究的目的是调查PIP - TAZ以及其他一些常用于治疗免疫功能低下患者感染的抗菌药物中曲霉半乳甘露聚糖抗原的存在情况和水平。通过商业EIA（Platelia Aspergillus EIA，Bio - Rad，法国）试剂盒测定PIP - TAZ、氨苄西林 - 舒巴坦、氨苄西林、青霉素G、头孢曲松、头孢吡肟、亚胺培南、克拉霉素、环丙沙星、万古霉素、庆大霉素、甲氧苄啶 - 磺胺甲恶唑、奥硝唑、氟康唑和两性霉素B中的半乳甘露聚糖抗原水平。用抗菌药物吸光度值与临界值的比值估算半乳甘露聚糖指数（GI），当GI > 0.5时判定为阳性。在所研究的15种抗生素中，仅氨苄西林检测出阳性结果，指数值最高（GI = 0.540），其次是PIP - TAZ，其值相对较高（GI = 0.235），尽管不在阳性范围内。其他抗生素的GI值范围为0.011至0.188。总之，对于通过EIA检测血清曲霉半乳甘露聚糖抗原的患者，为评估因交叉反应导致的假阳性结果，尤其应质疑氨苄西林（可能还有PIP - TAZ）治疗的使用情况。
