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Research Snapshot Theater: Infectious Disease/Pharmacology, Adult I

Impact of a Pharmacy-Driven (1,3)-β-D-Glucan Algorithm on Micafungin Duration of Therapy in the ICU

Sunday, March 22, 2026
2:30 PM - 3:30 PM Central Time
Location: Connections Central - RST 05
Introduction: The (1,3)-β-D-glucan (BDG) assay is a screening tool often used in combination with risk assessments to limit overutilization of antifungals with up to 80% reduction in micafungin duration of therapy (DOT). This stewardship approach could decrease potential drug toxicities, development of resistance, and excess costs. As there is no established consensus on the ideal patient population for use or use in combination with a defined algorithm, this study assessed the impact a BDG algorithm has on micafungin DOT compared to standard of care (SOC).


Methods: This retrospective, multisite, pre-post cohort study at a tertiary health system included non-neutropenic critically ill adults on empiric micafungin with risk factors for invasive candidiasis (IC). A BDG algorithm was utilized from 9/2024- 1/2025 and compared to SOC in the prior year for the primary outcome of micafungin DOT. Secondary outcomes included length of stay (LOS), mortality, 30-day readmissions, cost, and BDG performance. Statistical analyses included regression modeling, group comparisons, and correlation analyses.


Results: A total of 318 patients were screened to include 110 patients. Baseline characteristics were similar, with a lower rate of IC in the SOC than in the algorithm group (1.8% vs. 7.3%). Overall, micafungin DOT was not different between groups [94.7 (45.0-146.3) vs 95.4 (49.2-206.4) hours; p = 0.84] but was significantly shorter when BDG resulted within 48 hours [53.0 (46.1-98.1) vs. 140.7 (72.8-226.6) hours; p = 0.014] or with algorithm compliance following negative results [47.6 (35.6-68.8) vs 95.4 (49.2-206.4) hours; p = 0.005]. The test had negative and positive predictive values of 96.6% and 11.5%, respectively, with dialysis patients most likely to correlate with false positives (phi = 0.40, 95% CI: 0.15–0.60, p = 0.002). Patients who were immunocompromised or underwent surgery had prolonged DOT. Other outcomes were not significant.


Conclusions: A pharmacy-driven BDG algorithm did not significantly decrease micafungin DOT except with BDG results within 48 hours or with algorithm compliance following negative results. The BDG test may have less impact in immunocompromised, surgery, and dialysis patients. This highlights the need for research in anti-fungal stewardship to optimize patient outcomes.