Evaluating the Role of Serum Beta-D-glucan Testing in Safely Reducing Antifungal Therapy in Critically Ill Patients: A Retrospective Study.

IF 1.5 Q3 CRITICAL CARE MEDICINE

Indian Journal of Critical Care Medicine Pub Date : 2025-05-01 Epub Date: 2025-05-08 DOI:10.5005/jp-journals-10071-24961

Ripenmeet Salhotra, Debasish Biswal, Narayanan Sarat, Aayush Chawla, Sandeep Mangla, Pranjal Gupta, Rajeshwari Subramaniam

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Abstract

Background and aims: The role of (1→3)-β-D-glucan (BDG) testing in guiding antifungal therapy (AFT) in critically ill patients remains unclear. While BDG has a high negative predictive value (NPV), is it safe to withhold AFT in critically ill BDG-negative patients has not been well studied.

Patients and methods: This retrospective cohort study analyzed BDG-negative intensive care unit (ICU) patients (<60 pg/mL) at a tertiary care hospital from March 2024 to January 2025. The ICU survival was compared between those who received AFT and those who did not. Propensity score matching (PSM) adjusted for illness severity, and logistic regression identified independent predictors of survival.

Results: Among 100 BDG-tested patients, 53 (53%) were BDG-negative. Of these, 22 (41.5%) received AFT, while 31 (58.5%) did not. Unadjusted ICU survival was lower in the AFT group (45.5%) vs no AFT (80.6%) (p = 0.008). Antifungal therapy recipients had higher sequential organ failure assessment (SOFA) scores (9.7 ± 3.46 vs 7.4 ± 3.15, p = 0.014), indicating greater illness severity. Proven invasive candidiasis was rare (3.77%), with both cases due to Candida auris (p = 0.168). After PSM, survival differences were no longer significant (p = 0.246). Logistic regression confirmed AFT was not an independent predictor of survival [odds ratio (OR): 0.363, p = 0.156].

Conclusions: Withholding AFT in BDG-negative critically ill patients did not impact ICU survival, supporting BDG's role in antifungal stewardship. However, its limitations in detecting Candida auris warrant further prospective studies.

How to cite this article: Salhotra R, Biswal D, Sarat N, Chawla A, Mangla S, Gupta P, et al. Evaluating the Role of Serum Beta-D-glucan Testing in Safely Reducing Antifungal Therapy in Critically Ill Patients: A Retrospective Study. Indian J Crit Care Med 2025;29(5):413-417.

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评估血清β - d -葡聚糖检测在危重患者安全减少抗真菌治疗中的作用：一项回顾性研究。

背景与目的：（1→3）-β- d -葡聚糖（BDG）检测在指导危重患者抗真菌治疗（AFT）中的作用尚不清楚。虽然BDG具有很高的阴性预测值（NPV），但对于BDG阴性的危重患者，保留AFT是否安全还没有得到很好的研究。患者和方法：本回顾性队列研究分析了bdg阴性的重症监护病房（ICU）患者(结果：在100例bdg检测患者中，53例（53%）bdg阴性。其中22例（41.5%）接受了AFT治疗，31例（58.5%）未接受AFT治疗。AFT组未调整ICU生存率（45.5%）低于未AFT组（80.6%）（p = 0.008）。接受抗真菌治疗的患者有较高的顺序器官衰竭评估（SOFA）评分（9.7±3.46 vs 7.4±3.15,p = 0.014），表明疾病严重程度更高。证实侵袭性念珠菌病少见（3.77%），两例均为耳念珠菌所致（p = 0.168）。PSM后，生存差异不再显著（p = 0.246）。Logistic回归证实AFT不是生存的独立预测因子[比值比（OR）： 0.363, p = 0.156]。结论：在BDG阴性的危重患者中保留AFT不影响ICU的生存，支持BDG在抗真菌管理中的作用。然而，它在检测耳念珠菌方面的局限性值得进一步的前瞻性研究。本文引用方式：Salhotra R， Biswal D, Sarat N, Chawla A, Mangla S, Gupta P，等。评估血清β - d -葡聚糖检测在危重患者安全减少抗真菌治疗中的作用：一项回顾性研究。中华检验医学杂志，2015;29(5):413-417。

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来源期刊

Indian Journal of Critical Care Medicine CRITICAL CARE MEDICINE-

CiteScore

3.50

自引率

10.00%

发文量

299

期刊介绍： Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical and emergency medicine.