Work

Diagnostic and therapeutic capacity for fungal infections in Colombia: An ESCMID-EFISG nationwide multicenter assessment of mycological healthcare

Year: 2025

Type: article

Abstract: 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.

Source: International Journal of Infectious Diseases

DOI: 10.1016/j.ijid.2025.108182

Authors: Andres Ceballos-Garzon, Patricia Escandon, Jeisson Micelly, Oliver A. Cornely, Indira Berrio, Jon Salmanton-García