Measurement of the D-arabinitol/L-arabinitol ratio in urine of neutropenicpatients treated empirically with amphotericin B

The aim of the present study was to evaluate the diagnostic significance of the D-arabinitol/L-arabinitol ratio in urine of neutropenic patients with suspected fungal infection, D-arabinitol/L-arabinitol ratios were determine d in 373 serial urine samples of 104 patients with haematological malignanc ies receiving empirical amphotericin B treatment for suspected invasive fun gal infection. Twenty-eight (8%) urine samples obtained from 17 (16%) patie nts were positive (ratio greater than or equal to4), Eight (47%) patients h ad positive urine samples at the initiation of empirical amphotericin B tre atment and the rest from 7 to 30 days after empirical therapy was started. Several urine samples were positive in six patients. Only one of the five p atients with candidemia had elevated D-arabinitol/L-arabinitol ratios (pers istent Candida krusei fungaemia). Four patients with transient candidemia a nd seven patients with invasive mould infections were negative. Patients wh o died during the study period had significantly higher D-arabinitol/L-arab initol ratios than patients who survived (P=0.0002). Pneumonia was the most common manifestation of infection (53% of patients with elevated D-arabini tol/L-arabinitol ratios) and was associated with an especially high mortali ty (67%), The present study shows that elevated urine D-arabinitol/L-arabin itol ratios are common in febrile, neutropenic patients. However, the urine arabinitol test did not detect transient candidemia at elevated levels dur ing the course of infection. Furthermore, D-arabinitol/L-arabinitol ratios were often elevated in the late phase of infection only. This contests the use of this test in guiding the initiation of antifungal therapy. The detec tion of elevated arabinitol levels in neutropenic patients during empirical amphotericin B treatment is associated with poor prognosis.