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Journal of Clinical Microbiology, November 2006, p. 3894-3899, Vol. 44, No. 11
0095-1137/06/$08.00+0     doi:10.1128/JCM.01045-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Measurement of Serum D-Arabinitol/Creatinine Ratios for Initial Diagnosis and for Predicting Outcome in an Unselected, Population-Based Sample of Patients with Candida Fungemia{triangledown}

Siew Fah Yeo,1,3 Sharon Huie,3 Andre N. Sofair,3 Sheldon Campbell,2,4 Amanda Durante,3 and Brian Wong1,3*

Infectious Diseases Section,1 the Laboratory Service, VA Connecticut Healthcare System, West Haven, Connecticut,2 the Departments of Internal Medicine,3 Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut4

Received 18 May 2006/ Returned for modification 16 August 2006/ Accepted 23 August 2006

D-Arabinitol (DA) is a useful diagnostic marker for candidiasis in patients with neutropenia and other high-risk groups, but its use in unselected patients with a broad range of underlying diseases and conditions has not been studied. We used an automated enzymatic fluorometric assay to measure serum DA/creatinine ratios (DA/cr's) in 30 healthy adults, 100 hospitalized controls without Candida fungemia, and 83 patients from a study of all Candida fungemias in Connecticut between October 1998 and September 1999. Sixty-three of 83 (76%) fungemic patients and 11 of 100 (11%) nonfungemic controls had serum DA/cr's ≥3.9 µM/mg/dl (mean + 3 standard deviations for 30 healthy adults). High serum DA/cr's were less frequent in patients with cancer or fungemia caused by the DA nonproducer Candida glabrata than in patients with cancer or fungemia caused by a DA producer, C. albicans, C. tropicalis, or C. parapsilosis. The serum DA/cr was first ≥3.9 µM/mg/dl before, on the same day as, or after the first positive blood culture was drawn for 30 (36%), 22 (27%), and 11 (13%) fungemia patients, respectively. Mortality did not differ significantly among the patients with high or normal initial or peak serum DA/cr's, but mortality was higher if any serum DA/cr value was ≥3.9 µM/mg/dl 3 or more days after the onset of fungemia (18/27 versus 4/24 patients, respectively; P < 0.001). We conclude that serum DA/cr's are useful both for the initial diagnosis of Candida fungemia and for prognostic purposes for unselected patients with a broad range of underlying diseases and conditions.

* Corresponding author. Present address: Division of Infectious Diseases, Oregon Health and Science University, 3181 SW Sam Jackson Park Road (NRC-3), Portland, OR 97239. Phone: (503) 494-7735. Fax: (503) 494-4264. E-mail: wongbri{at}ohsu.edu.

{triangledown} Published ahead of print on 6 September 2006.

Journal of Clinical Microbiology, November 2006, p. 3894-3899, Vol. 44, No. 11
0095-1137/06/$08.00+0     doi:10.1128/JCM.01045-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.





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