Assessing laboratory capacity for diagnosis of fungal infections in France: A multicentre survey within the SINFONI network

Invasive fungal diseases are life-threatening complications, particularly in immunocompromised patients, and require rapid and accurate diagnosis to improve clinical outcomes. Although major advances in fungal diagnostics that includes antigen detection, molecular assays, and Matrix-Assisted Laser Desorption/Ionization - Time Of Flight (MALDI-TOF) mass spectrometry, have transformed diagnostic strategies, access to these tools remains heterogeneous. In France, national data on diagnostic capacities for invasive fungal diseases have been lacking. Using the framework of the national prospective surveillance program for invasive fungal diseases (SINFONI network), we conducted a survey to assess laboratory diagnostic practices in France. A secured 116-item questionnaire was distributed to 58 participating laboratories, of which 48 responded (83%). Automated blood culture systems and MALDI-TOF mass spectrometry for yeast identification were universally available, with 40 (83%) of the 48 participating laboratories also using MALDI-TOF for mould identification. Antifungal susceptibility testing was performed on-site in 47 (98%) centres for yeasts and in 37 (77%) for moulds. Antigen-based biomarkers were widely available on-site, particularly cryptococcal antigen (n = 43, 90%) and Aspergillus galactomannan (n = 39, 81%), whereas β-D-glucan testing was available in only 26 (54%) of the centres. PCR-based diagnostics were implemented on-site in 43 (88%) centres, most commonly for Pneumocystis jirovecii, Aspergillus spp., and Mucorales. Systematic screening for Candidozyma auris colonization in at-risk patients was performed in 30 (63%) centres, predominantly using culture-based methods (n = 24). Overall, this survey provides the first national overview of diagnostic capacities for invasive fungal diseases in France, highlighting a strong laboratory mycology infrastructure while identifying remaining gaps in access to specific biomarkers, molecular assays, and mould antifungal susceptibility testing.