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JAC Advance Access originally published online on August 30, 2006
Journal of Antimicrobial Chemotherapy 2006 58(4):806-810; doi:10.1093/jac/dkl334
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Kinetics of galactomannan in surgical patients receiving perioperative piperacillin/tazobactam prophylaxis

M. Machetti1,2, M. J. Majabo2,3, E. Furfaro1,2, N. Solari4, A. Novelli5, F. Cafiero4 and C. Viscoli1–3,6,*

1 Advanced Biotechnology Center, Largo R. Benzi 10 16132 Genova, Italy 2 Infectious Diseases Unit, National Institute for Cancer Research, Largo R. Benzi 10 16132 Genova, Italy 3 Department of Endocrinologic and Metabolic Sciences, University of Genova, Largo R. Benzi 10 16132 Genova, Italy 4 Department of Surgery, National Institute for Cancer Research, Largo R. Benzi 10 16132 Genova, Italy 5 Department of Pharmacology, University of Firenze, P.zza S.Marco 4 50121 Firenze, Italy 6 Division of Infectious Diseases, San Martino Hospital, Largo R. Benzi 10, 16132 Genova, Italy

Received 10 April 2006; returned 14 June 2006; revised 3 July 2006; accepted 19 July 2006

*Correspondence address. Division of Infectious Diseases, San Martino Hospital, Largo R. Benzi 10, 16132 Genova, Italy. Tel: +39-0105555121; Fax: +39-0103537680; E-mail: viscolic{at}unige.it

Objectives: The association between piperacillin/tazobactam and the positivity of the galactomannan (GM) detection ELISA test is well described. Little information is available about the kinetics of GM in patients treated with piperacillin/tazobactam. The present study aimed at clarifying the baseline interaction between piperacillin/tazobactam and GM in patients receiving this drug.

Patients and methods: Seven patients undergoing abdominal surgery received perioperative prophylaxis with piperacillin/tazobactam. Each patient received three doses of 4.5 g of the drug, administered at 8 h intervals (one before and two after surgery). Three patients received antibiotic batches with ‘medium’ (GM-index = 1.782) and four patients received antibiotic batches with ‘high’ (GM-index = 6.665) GM content. Serum samples for GM evaluation were collected before drug infusion and at times +1, +3, +6 and +8 h after the first and third infusions.

Results: GM levels increased after infusion, in particular when batches with ‘high’ GM content were used. Moreover, a non-statistically significant increase between the first dose and the third dose was observed. All samples taken >6 h after administration were negative (GM-index < 0.2), both with the ‘medium’ and the ‘high’ GM content batches.

Conclusions: The low content of GM 8 h after piperacillin/tazobactam infusion suggests that in non-neutropenic cancer patients with solid tumours receiving up to three doses of piperacillin/tazobactam, serum sampling for GM detection should be performed immediately before the next piperacillin/tazobactam administration.

Keywords: fungal infections , antigen detection false positives , diagnosis interactions


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