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

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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.

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