1.
False-positive Candida and Aspergillus antigen testing in recipients of allogeneic hematopoietic cell transplantation due to administration of parenteral nutrition and fixed combinations of piperacillin-tazobactam
Walter, W., Bornhauser, M., Stolzel, F., Knoth, H.
Mycoses. 2019
Abstract
BACKGROUND False-positivity of antigen immunoassays used as an early diagnostic tool to detect invasive fungal infections are known. Interpretation of the assay needs the identification of sources which could affect the specificity of the test. OBJECTIVES We focused on the influence of parenteral nutrition (PN) and piperacillin-tazobactam (TZP) on fungal immunoassays. Measurable amounts of Candida antigen mannan were detected in several compounds of PN and TZP in a previous in-vitro study. PATIENTS/ METHODS In the current study, 84 patients undergoing allogeneic hematopoietic cell transplantation receiving either TZP, PN or both were monitored with Aspergillus and Candida antigen assay. Six patients were analyzed closer in a kinetic analysis with more frequent blood sampling to detect mannan. RESULTS PN in diverse compositions as well as TZP did not increase significantly the amount of mannan and the Aspergillus antigen in serum. We could not confirm the positive results of the in-vitro study. CONCLUSIONS Physicians should be aware that mannan antigenemia due to drug infusion could be a transient issue and should be considered in the interpretation of fungal immunoassays, although we could not find clinically relevant effects on mannan levels. This article is protected by copyright. All rights reserved.
2.
Clostridium Difficile infections in patients with AML or MDS undergoing allogeneic hematopoietic stem cell transplantation identify high risk for adverse outcome
Amberge, S., Kramer, M., Schrottner, P., Heidrich, K., Schmelz, R., Middeke, J. M., Gunzer, F., Hampe, J., Schetelig, J., Bornhauser, M., et al
Bone marrow transplantation. 2019
Abstract
Clostridium difficile (CD) infection is the main cause of nosocomial enterocolitis in western countries and in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHCT). Recipients of alloHCT are at high risk for CD infection but large studies in this population are rare and conflicting results have been reported. We analyzed 727 patients with AML or MDS undergoing alloHCT in our center from 2004 to 2015. Ninety-six patients (13%) had CD infection and 103 patients (14%) were identified as asymptomatic carriers by screening at admission and once a week during aplasia. Patients with CD infection had a shorter median overall survival of 8 months (95% CI, 6-36 months) compared with 25 months (95% CI, 17-35 months) for patients without CD infection, (HR 1.4, p = 0.04). CD positive patients were less likely to develop acute graft-versus-host disease (aGvHD; HR 0.6, p = 0.004) compared with CD-negative patients, but did not show differences in gastrointestinal aGvHD (HR 0.9, p = 0.5). Symptomatic patients developed gastrointestinal aGvHD (HR 2.5, p = 0.02) more often compared with asymptomatic CD positive patients. This analysis demonstrates a high prevalence for CD infection in patients undergoing alloHCT. A significant lower overall survival for patients with CD infection could be demonstrated.