Although the management of invasive fungal infections (IFIs) is well structured in France, diagnostic capacities may vary between centres. To assess the availability of diagnostic tools and antifungal management in major French hospitals, we conducted a national survey using a standardized questionnaire developed by the European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology (ISHAM).

The questionnaire was distributed through a publicly accessible link and disseminated via scientific societies and professional contacts. The questionnaire included sections on institutional profiles, patient demographics, diagnostic tools employed for fungal infections, and the range of antifungal medications available. A comparison between university and non-University hospitals was performed.

Between January 2023 and June 2023, 50 centres (39 university hospitals and 11 general hospitals) responded. The main pathogens of concern were Candida spp., Aspergillus spp., and Mucorales. All laboratories performed direct examination and fungal culture , without significant difference between university hospitals and general hospitals, except for access to fluorescence microscopy for direct examination, which was rarely used in general hospitals. Mass Spectrometry (MALDI-TOF MS) was used for fungal identification in 97.9% of laboratories, and 62.5% had access to DNA sequencing. For all serological (BD glucan, galactomannan, antibody detection) and molecular tools used for the diagnosis of fungal infections, on-site availability differed significantly between university hospitals and general hospitals, with the latter referring their tests to laboratories within the French network.

Overall, 97.9% of centres had access to antifungal susceptibility testing, most commonly using a gradient diffusion method. All hospitals had access to major antifungal drug classes and to therapeutic drug monitoring for azoles and flucytosine, with a significant difference between University hospitals and general hospitals regarding access to drug-level testing.

This survey provides a comprehensive overview of clinical mycology capacities in France and demonstrates a high level of diagnostic and therapeutic preparedness for managing IFIs.