PSHP 2026 Residency Conference

Purpose: Given the opportunity to optimize micafungin therapy in obese patients, our institution established a new protocol that recommends high doses for patients > 125 kg. We aimed to evaluate the outcomes associated with this new protocol.
 
Methods: This is a retrospective cohort study of patients at Thomas Jefferson University Hospital Inc locations from December 2024 to March 2026. Patients were included if they were 18 years or older, had documented invasive candidiasis, and received micafungin for 3 or more days. Patients were excluded if they had a concomitant infection within 7 days, were given empiric combination antifungal therapy, or had Candida species isolated from the genitourinary tract. Outcomes will be compared between patients weighing ≤ 125kg, patients weighing > 125kg on standard dose micafungin, and patients weighing > 125kg on high dose micafungin. The primary outcome is a composite of all–cause 90-day mortality, microbiologic and clinical cure, and incidence of recurrent infections within 30 days. The secondary outcomes are 30-day infection related readmission, duration of micafungin treatment, hospital and ICU length of stay and duration of candidemia.
 
Results: A total of 318 positive Candida cultures were identified and of those, 271 patients were removed to meet the exclusion criteria. Therefore, the study cohort included a total of 42 patients with 40 patients in the ≤ 125kg group, 1 patient in the > 125kg with standard micafungin dose group, and 1 patient in the > 125kg with high micafungin dose group. No difference was seen with the primary composite outcome between the cohorts (p=0.448). Due to low enrollment, exploratory analysis was performed utilizing binomial linear regression. When including mg/kg dosing as a continuous variable and analyzed it with other impactful and confounding variables, we did not find that it added significantly to the model. 
 
Conclusion: Our results from a very limited data set suggest that increased micafungin dosing in obese patients was not associated with improved clinical outcomes for invasive candidiasis. Exploratory analysis did not suggest that higher micafungin dosing (measured in mg/kg) provided additional benefit. Our institution will continue to collect data, in hopes of generating a greater sample size. Larger studies are required to confirm these results.