Mind the Gap: A Nationwide Survey on Diagnostic and Therapeutic Capacity for Invasive Fungal Infections in Chile

Background: Invasive fungal infections can cause morbidity and mortality, particularly among immunocompromised and critically ill patients, making them an important global public health problem. Outcomes depend on timely diagnosis, laboratory capacity, and access to effective antifungal therapy. As national data describing these resources in Chile remain limited, we aimed to characterize national gaps in mycological diagnostic and therapeutic access. Methods: We conducted a nationwide survey of physicians, pharmacists, and laboratory professionals representing Chilean hospitals. Multiple responses from the same institution were consolidated. A 15-item diagnostic and therapeutic access score was developed to assess differences between hospitals. Results: Thirty-five hospitals participated in the survey. Diagnostic infrastructure varied substantially across institutions; all hospitals reported access to direct mycological examination, among which 65.7% had access to MALDI-TOF MS and 51.4% used molecular identification methods. The access score differed significantly according to hospital size, with median scores of 53.3% (20.0–80.0), 66.7% (46.7–86.7), and 73.3% (60.0–86.7) in hospitals with 0–300, 301–499, and ≥500 beds, respectively (p = 0.003). Conclusions: This nationwide assessment identified size-dependent inequities in mycological capacity in Chile, with larger hospitals having greater diagnostic and therapeutic access. These findings support targeted national strategies to strengthen smaller institutions and ensure equitable care.