title: Clinical experience of urine D-arabinitol/L-arabinitol ratio in the early diagnosis of invasive candidiasis in paediatric high risk populations.
abstract: In 2 prospective studies, we previously reported on the early and accurate diagnosis of invasive candidiasis by determining the D-arabinitol/L-arabinitol (DA/LA) ratio in urine in neutropenic children with cancer at the paediatric oncology unit (POU) and in premature infants at the neonatal intensive care unit (NICU) at our hospital. In this retrospective study at the same units, we report how the DA/LA assay was implemented in clinical practice immediately after the prospective study periods. We found that, in the POU, the recommendation of regularly monitoring urine DA/LA ratios in patients at risk and considering antifungal therapy in the case of elevated ratios had been followed. A significant decrease in the incidence of culture positive invasive candidiasis may have been attributed to the introduction of the DA/LA assay. At the NICU, where the DA/LA assay was recommended only as an adjunct to other diagnostic tools, morbidity in invasive candidiasis remained unchanged. While regular monitoring of the urine DA/LA ratio probably facilitates the early detection of invasive candidiasis in paediatric oncology, it remains to be determined if the test can be used in a similar way in neonatal intensive care.
authors: Centre for Infectious Disease Control, Directorate of Health, Department of Clinical Microbiology, Landspitali University Hospital, Iceland. gudrun@landlaeknir.is
authors: Gudrun
authors: G
authors: Sigmundsdottir
authors: Lennart
authors: L
authors: Larsson
authors: Thomas
authors: T
authors: Wiebe
authors: Lars J
authors: LJ
authors: Björklund
authors: Bertil
authors: B
authors: Christensson
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000652:urine*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016522:Oncology Service, Hospital; D012307:Risk Factors; D013402:Sugar Alcohols / Q000652:urine*
chemical_list: D000935:Antifungal Agents; D013402:Sugar Alcohols; C014999:arabitol