Abstract
Background: Studies on false-positive galactomannan (GM) enzyme immunoassay (EIA) results and treatment for critically ill patients are scarce. Objectives: The study aimed to determine the false-positive rate of GM-EIA and to probe the risk factors of false positivity among patients in the intensive care units (ICUs). Methods: A case–control approach was conducted to review adult patients who had at least one GM-EIA result and were admitted to the ICU. Those who had no fungal culture were excluded. The clinical characteristics and critical care between patients with false-positive and true-negative GM index (GMI) were compared. Results: Of 206 patients enrolled and with GM-EIA results, 20 (9.7%) were considered to have false-positive antigenemia, including 9 in bronchoalveolar lavages (BAL) and 11 in serum. A total of 148 (71.8%) were true-negatives. After paired grouping of 1:4, factors researched in the previous studies showed no significant difference. However, compared with the true-negatives, patients with positive GM test results but were incompatible with the diagnosis of invasive aspergillosis were more prone to the risk of false positivity due to the use of colistin inhalation. It seemed to be the only factor that significantly increased the risk of false positivity after multivariate analysis (adjusted odds ratio, 35.68; 95% CI, 3.77–337.51, p = 0.002). Conclusions: Colistin inhalation treatment may contribute to false-positive GM-EIA results. The positive GMI among patients receiving colistin nebulization should be interpreted with caution.
Highlights
Invasive aspergillosis (IA) is an important cause of fatality among immunocompromised patients
The study aimed to determine the false-positive rate of GM-enzyme immunoassay (EIA) and to probe the risk factors of false positivity among patients in the intensive care units (ICUs)
Compared with the true-negatives, patients with positive GM test results but were incompatible with the diagnosis of invasive aspergillosis were more prone to the risk of false positivity due to the use of colistin inhalation
Summary
Invasive aspergillosis (IA) is an important cause of fatality among immunocompromised patients. The incidence of IA has been increasing in Taiwan. An 11-year (2002–2012) follow-up report showed that 147 (36.12%) patients were admitted to the intensive care unit (ICU) (Sun et al, 2017). Neutropenic patients and non-neutropenic patients are candidates to develop one or another form of aspergillosis (Vandewoude et al, 2016). The severity, multiple diseases, and high-dose steroids frequently used in the ICU may enhance the chance of aspergillosis (Meersseman et al, 2007). Diagnosis of IA among critically ill patients became important. Studies on false-positive galactomannan (GM) enzyme immunoassay (EIA) results and treatment for critically ill patients are scarce
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