{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:15:30Z","timestamp":1789391730620,"version":"build-2803163510"},"reference-count":174,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Asociaci\u00f3n Colombiana de Infectolog\u00eda (ACIN), SurOccidente Chapter"},{"id":[{"id":"https:\/\/ror.org\/0431fz439","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Diagnostic failure in invasive fungal infections (IFIs) remains a relevant and underrecognized cause of mortality, morbidity, delayed therapy, unnecessary antifungal exposure, and pharmacological selective pressure. Although major advances have been achieved in biomarkers, rapid diagnostic tests, molecular methods, imaging studies, and microbiological identification, timely diagnosis continues to be influenced by the interaction among host factors, pathogen-related factors, diagnostic tools, and healthcare system\u2013related factors. This narrative review analyzes diagnostic failure in IFIs as a dynamic process that includes delayed, incorrect, and incomplete diagnosis. It examines its determinants and consequences in high-risk populations\u2014critically ill patients, patients with hematologic diseases or hematopoietic stem cell transplant recipients, and neonates\u2014as well as in invasive candidiasis, aspergillosis, mucormycosis, cryptococcosis, endemic mycoses, and infections caused by rare or emerging fungi. It also reviews how delayed sampling, decontextualized interpretation of biomarkers, incomplete microbiological identification, absence of antifungal susceptibility testing when clinically relevant, and fragmentation between clinical and laboratory teams contribute to adverse outcomes. Finally, it proposes a diagnostic-centered antifungal stewardship framework (AFSP-Dx) based on syndromic bundles, population-specific diagnostic algorithms, 48\u201372 h reassessment, and auditable indicators intended to support earlier recognition, more precise therapeutic decisions, and rational antifungal use.<\/jats:p>","DOI":"10.3390\/jof12070498","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T17:27:31Z","timestamp":1783531651000},"page":"498","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diagnostic Failure in Invasive Fungal Infections: Causes, Clinical Consequences, and Mitigation Strategies"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6034-3182","authenticated-orcid":false,"given":"Pilar","family":"Rivas-Pinedo","sequence":"first","affiliation":[{"name":"Medical and Diagnostic Mycology Group, Department of Microbiology, Faculty of Medicine, Universidad Nacional de Colombia, Bogot\u00e1 111321, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6180-792X","authenticated-orcid":false,"given":"Jos\u00e9 Mill\u00e1n","family":"O\u00f1ate Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"One Health Research Group for Infectious Diseases, Keralty, Department of Internal Medicine, Cl\u00ednica Colsanitas S.A., Cl\u00ednica Sebasti\u00e1n de Belalc\u00e1zar, Cali 760045, Colombia"},{"name":"Infectious Diseases Service, Cl\u00ednica Imbanaco, Cali 760042, Colombia"},{"name":"Clinical Research and Education Group (GIEDCO), Cl\u00ednica de Occidente, Cali 760035, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"165rv13","DOI":"10.1126\/scitranslmed.3004404","article-title":"Hidden killers: Human fungal infections","volume":"4","author":"Brown","year":"2012","journal-title":"Sci. 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