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Bio-energetics Investigation of Candida albicans Using Real-time Extracellular Flux Analysis
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Published on: March 19, 2019

Diagnostic Failure in Invasive Fungal Infections: Causes, Clinical Consequences, and Mitigation Strategies

Pilar Rivas-Pinedo1, José Millán Oñate Gutiérrez2,3,4

  • 1Medical and Diagnostic Mycology Group, Department of Microbiology, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá 111321, Colombia.

Journal of Fungi (Basel, Switzerland)
|July 27, 2026
PubMed

Insights

Diagnostic failure in invasive fungal infections (IFIs) leads to poor outcomes. A new framework, AFSP-Dx, aims to improve early recognition and treatment through better diagnostics and stewardship.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Diagnostic Microbiology

Background:

  • Diagnostic failure in invasive fungal infections (IFIs) is a significant cause of mortality and morbidity.
  • Despite advances in diagnostic tools, timely diagnosis remains challenging due to complex interactions between host, pathogen, and healthcare systems.

Purpose of the Study:

  • To analyze diagnostic failure in IFIs as a dynamic process, examining its determinants and consequences.
  • To propose a diagnostic-centered antifungal stewardship framework (AFSP-Dx) to improve diagnostic accuracy and therapeutic decisions.

Main Methods:

  • Narrative review of diagnostic failure in IFIs across various high-risk populations and fungal pathogens.
  • Analysis of factors contributing to diagnostic failure, including delayed sampling and fragmented team communication.
  • Development of the AFSP-Dx framework incorporating syndromic bundles and population-specific algorithms.

Main Results:

  • Diagnostic failure encompasses delayed, incorrect, and incomplete diagnoses, impacting critically ill patients, transplant recipients, and neonates.
  • Specific IFIs like candidiasis, aspergillosis, and mucormycosis are frequently affected by diagnostic delays.
  • Incomplete microbiological identification and lack of susceptibility testing exacerbate adverse outcomes.

Conclusions:

  • The AFSP-Dx framework offers a structured approach to enhance early recognition and precise treatment of IFIs.
  • Implementing auditable indicators and population-specific algorithms can rationalize antifungal use and improve patient care.
  • Addressing diagnostic fragmentation and improving laboratory-clinical collaboration are crucial for mitigating IFI-related mortality.
Keywords:
antifungal stewardshipdelayed diagnosisdiagnostic failurediagnostic stewardshipfungal biomarkershigh-risk populationsinvasive aspergillosisinvasive candidiasisinvasive fungal infectionsmucormycosis

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