Abstract 1613 Poster Session II, Sunday, 5/2 (poster 124)

D-arabinitol is a metabolite of most pathogenic Candida species. Both D-arabinitol and L-arabinitol are present in normal urine, and can easily be measured by gas chromatography of urine samples collected on filter paper. An elevated urine DA/LA ratio is a sensitive early sign of invasive candidiasis in children with cancer (J Clin Microbiol 1997;35:636-640), but the method has not previously been evaluated in newborn infants. We measured urine DA/LA ratio in 40 healthy full-term infants, 0-3 days of age, and in 77 hospitalized infants in the neonatal intensive care unit (gestational age 25-41 weeks, 184 samples), in whom invasive candidiasis was not suspected and no systemic antifungal treatment given. Urine DA/LA ratio was 2.5±0.6 in the healthy newborns and 2.8±0.9 in the hospitalized infants (mean±SD). We used a ratio of 4.6 (mean + 2SD of hospitalized infants) as the upper normal limit. DA/LA ratios were also measured in five infants treated with fluconazole, two of whom had growth of Candida in deep locations. All five infants had at least one DA/LA ratio above 4.6. Three infants, including one with verified candidemia, had repeatedly elevated DA/LA ratios (maximum 10.2), which returned to normal after fluconazole treatment. The figure shows DA/LA ratios in a 24 weeks' gestational age infant, with suspected invasive candidiasis but negative cultures. We conclude that urine DA/LA ratios can be used in diagnosing invasive candidiasis and in monitoring the effect of antifungal treatment in sick newborn infants.

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