Mean number of serum samples per episode was 9.4 in this study,

whereas it was 36.5 (in proven IA episodes) and 30.6 (in all episodes) in the series of Maertens, where 100% sensitivity was reported.12,32 The requirement of two consecutive results for positivity further decreased the sensitivity, given the fact that in 38% of the episodes, more than 7 days have elapsed in between two samples. In ideal study conditions, however, these patients would be excluded from the analysis.33 Second, the lack of invasive diagnostic Selleck BAY 57-1293 interventions and autopsy probably had a great impact.12 Many of the possible and probable cases could have been upgraded to a higher level if microbiological criteria had been obtained. The performance of GM assay has been much worse in studies evaluating routine practices in which an ideal study setting could not be constructed.34 Another factor may be the high rate of empirical antifungal drug use in episodes with a prior or current episode of suspected selleck kinase inhibitor IA, or with cavitary lesions in the lungs.

This might have led to negative GM results because of the decreased release of the molecule into the bloodstream and especially in patients with mild infection.14 There might have been problems also during the transport and the storage of the specimens that we could not have controlled, which might have led to false negative results. Moreover, patients ZD1839 purchase who encountered Aspergillus before their follow-up episodes might have developed anti-Aspergillus antibodies, which is a reported cause of GM false negativity.25 The GM-ELISA assay has been shown to demonstrate specificity of above 90% in most

reports, contrary to this study, which documented a very poor specificity. The high false positivity of the method might be related to several factors in this study. First of all, concomitant beta lactam use such as piperacillin-tazobactam and amoxicillin-clavulanate might have contributed to some extent as reported previously.35–39 It seems as if cefepime is a reason for false positivity with regard to data in Table 4, however, it is very hard to conclude that cefepime cross reacts with GM. The empirical treatment for febrile neutropenia in our hospital included cefepime during the study period, so nearly all the patients were treated with this beta lactam antibiotic including those with false positive GM results. Moreover, the frequency of the GM testing is not adequate to conclude that cefepime is a causative agent for false positivity. Fungal infections other than IA may yield positive GM results. Histoplasma, Penicillium, Cryptococcus, and Blastomyces are among the fungi that have been reported to cause false positive results.40–43 There are controversial reports regarding Fusarium.43,44 The disseminated fusariosis case in this study yielded two positive results among 18 measurements, and no other fungal infection could be shown.