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JAC Advance Access published online on August 30, 2006
Journal of Antimicrobial Chemotherapy, 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
Received April 10, 2006
Revised July 3, 2006
Accepted July 19, 2006

Original article

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

M. Machetti 1, M. J. Majabo 2, E. Furfaro 1, N. Solari 3, A. Novelli 4, F. Cafiero 3, and C. Viscoli 5 *

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

* To whom correspondence should be addressed.
C. Viscoli, E-mail: viscolic{at}unige.it


  Abstract

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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