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Dextrose-containing fluids causing false-positive serum galactomannan: a case-control study and interrupted time
Raeseok Lee1, In Young Yoo2, Eun-Jee Oh2
1Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Dextrose-containing fluids were identified as the cause of false-positive Aspergillus antigen galactomannan (GM) tests. Restricting their use significantly reduced false-positive GM results, improving diagnostic accuracy.
Area of Science:
- Clinical Microbiology
- Diagnostic Immunology
Background:
- False-positive results in Aspergillus antigen galactomannan (GM) testing can lead to misdiagnosis and inappropriate treatment.
- Identifying the source of these false positives is crucial for accurate patient management.
Purpose of the Study:
- To investigate and identify the specific cause of false-positive serum Aspergillus antigen GM results in a clinical setting.
- To implement and evaluate an intervention to mitigate these false-positive findings.
Main Methods:
- A case-control study design was employed to compare patients with false-positive GM results to those with true-negative results.
- Multivariable regression analysis identified independent risk factors, and interrupted time series analysis assessed intervention effectiveness.
- Analysis included testing of dextrose-containing fluids and investigation of manufacturing processes.
Main Results:
- Dextrose-containing fluid administration within six days prior to testing was a significant independent predictor of false-positive GM results (aOR, 18.60).
- Aspergillus niger-derived enzymes used in the saccharification process of dextrose fluids were identified as the root cause.
- Following restricted use of these fluids, a significant reduction in false-positive GM results was observed, with an immediate decrease and a sustained declining trend.
Conclusions:
- The use of dextrose-containing intravenous fluids is the primary factor contributing to false-positive serum Aspergillus antigen GM assay results.
- Modifications to the manufacturing process of dextrose-containing fluids were implemented based on study findings to prevent future false positives.
