Abstract 12

Background: 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 determined 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.

Patients and measurements: 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. DA/LA ratio was also measured in five infants treated with fluconazole, two of whom had growth of Candida in deep locations.

Results: Urine DA/LA ratio was 2.5±0.6 in the healthy newborns and 2.8±0.9 in the hospitalized infants without systemic candidiasis (mean±SD). We used a ratio of 4.6 (mean + 2SD in hospitalized infants) as the upper normal limit. All five infants treated with fluconazole 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.

Conclusion: Urine DA/LA ratios can be used in diagnosing invasive candidiasis and in monitoring the effect of antifungal treatment in sick newborn infants.