TY - JOUR
T1 - Diagnostic and therapeutic capacity for fungal infections in Colombia
T2 - An ESCMID-EFISG nationwide multicenter assessment of mycological healthcare
AU - Ceballos-Garzon, Andres
AU - Escandon, Patricia
AU - Micelly, Jeisson
AU - Cornely, Oliver A.
AU - Berrio, Indira
AU - Salmanton-García, Jon
N1 - Publisher Copyright:
© 2025 The Authors.
PY - 2026/1
Y1 - 2026/1
N2 - Objectives: This study aims to evaluate nationwide diagnostic and treatment capacity for IFD across Colombia’s diverse healthcare system. Methods Between March and September 2024, a cross-sectional survey assessed institutional profiles, diagnostic access (microscopy, culture, antigen, polymerase chain reaction [PCR] testing, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry [MALDI-TOF MS]), antifungal availability, and therapeutic drug monitoring (TDM) practices. Responses were collected from 133 institutions (113 hospitals, 20 research centers) across 26/33 departments. Results Among 179 complete responses (94 microbiologists, 85 physicians) Candida spp. (39%), Cryptococcus spp. (20%), Aspergillus spp. (18%), and Histoplasma spp. (14%), were the pathogens considered to be more worrisome. Conventional diagnostics showed broad availability (microscopy: 94%, culture: 74%), while advanced tools were limited (e.g., MALDI-TOF MS: 12%). Antigen testing access varied by pathogen ( Cryptococcus spp.: 54%, Aspergillus spp.: 52%, Histoplasma spp.: 44%), with metropolitan-rural disparities ( P ≤0.001). Antifungal susceptibility testing was available only in 56% of the surveyed institutions. Antifungal access revealed inequities: liposomal amphotericin B (68%), echinocandins (76%), and triazoles (97%) mainly accessible in metropolitan centers. HSCT/solid organ transplant (SOT) recipients had superior access to antifungals. TDM access was limited (voriconazole/itraconazole: 32%). Conclusion Conventional mycological methods remain the cornerstone of fungal diagnosis in Colombia. Significant disparities in IFD management capacity persist, with metropolitan centers and transplant recipients disproportionately benefiting from advanced resources. Although Colombia has established clinical guidelines incorporating World Health Organization (WHO)-recommended diagnostics and treatments, urgent nationwide implementation efforts are required to translate these recommendations into routine clinical practice and address persistent geographic and socioeconomic inequities in patient care.
AB - Objectives: This study aims to evaluate nationwide diagnostic and treatment capacity for IFD across Colombia’s diverse healthcare system. Methods Between March and September 2024, a cross-sectional survey assessed institutional profiles, diagnostic access (microscopy, culture, antigen, polymerase chain reaction [PCR] testing, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry [MALDI-TOF MS]), antifungal availability, and therapeutic drug monitoring (TDM) practices. Responses were collected from 133 institutions (113 hospitals, 20 research centers) across 26/33 departments. Results Among 179 complete responses (94 microbiologists, 85 physicians) Candida spp. (39%), Cryptococcus spp. (20%), Aspergillus spp. (18%), and Histoplasma spp. (14%), were the pathogens considered to be more worrisome. Conventional diagnostics showed broad availability (microscopy: 94%, culture: 74%), while advanced tools were limited (e.g., MALDI-TOF MS: 12%). Antigen testing access varied by pathogen ( Cryptococcus spp.: 54%, Aspergillus spp.: 52%, Histoplasma spp.: 44%), with metropolitan-rural disparities ( P ≤0.001). Antifungal susceptibility testing was available only in 56% of the surveyed institutions. Antifungal access revealed inequities: liposomal amphotericin B (68%), echinocandins (76%), and triazoles (97%) mainly accessible in metropolitan centers. HSCT/solid organ transplant (SOT) recipients had superior access to antifungals. TDM access was limited (voriconazole/itraconazole: 32%). Conclusion Conventional mycological methods remain the cornerstone of fungal diagnosis in Colombia. Significant disparities in IFD management capacity persist, with metropolitan centers and transplant recipients disproportionately benefiting from advanced resources. Although Colombia has established clinical guidelines incorporating World Health Organization (WHO)-recommended diagnostics and treatments, urgent nationwide implementation efforts are required to translate these recommendations into routine clinical practice and address persistent geographic and socioeconomic inequities in patient care.
UR - https://www.scopus.com/pages/publications/105023495715
UR - https://www.scopus.com/pages/publications/105023495715#tab=citedBy
U2 - 10.1016/j.ijid.2025.108182
DO - 10.1016/j.ijid.2025.108182
M3 - Research Article
C2 - 41192549
AN - SCOPUS:105023495715
SN - 1201-9712
VL - 162
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
M1 - 108182
ER -
