A Diagnostic Stewardship Intervention to Improve Utilization of 1,3 β-D-Glucan Testing at a Single Academic Center: Five-Year Experience

Abstract

Background (1,3)- β-D-glucan (BDG) testing is one of the non-invasive tests to aid diagnosis of invasive fungal infections (IFI). The study results have been heterogenous and diagnostic performance varies depending on the risks for IFI. Thus, it is important to select appropriate patients for BDG testing to prevent false positive results. An algorithmic diagnostic stewardship intervention was instituted at a single academic medical center to improve BDG test utilization. Methods The BDG test order in the electronic health record was replaced with the BDG test request order that required approval to process the actual test order. The approval criteria were 1) immunocompromised or ICU patient, and 2) on empiric antifungal therapy, or inability to undergo invasive diagnostic procedures. A retrospective observational study was conducted to evaluate the efficacy of the intervention by comparing the number of the BDG tests performed between 1-year pre- and post-intervention. The safety was assessed by chart review of the patients for whom BDG test requests were deemed inappropriate and rejected. Results The number of BDG tests performed per year decreased by 85% from 156 in the pre-intervention to 24 in the post-intervention period. The average monthly number of the BDG tests performed was significantly less comparing between those periods (P 0.002). There was no delay in IFI diagnosis or IFI-related deaths in the patients whose BDG test requests were rejected. The sustained effectiveness of the intervention was observed for 5 years. Conclusions Institution of the diagnostic stewardship intervention successfully and safely improved BDG test utilization.