Gaps in fungal disease diagnostics and availability of antifungals: A nationwide survey of hospital laboratories in Peru.

Fungal infections remain an underrecognized public health threat in Peru. This study aimed to map the current laboratory diagnostic capacity for fungal diseases across Peru and identify potential barriers to timely and effective diagnosis. A cross-sectional electronic survey of 42 hospital laboratories was conducted from December 2021 to August 2022, evaluating infrastructure, personnel, diagnostic tests, sample volumes, quality assurance, and training. Descriptive and exploratory comparative analyses were performed by location (Lima vs. other regions) using Wilcoxon rank-sum, Fisher's exact tests, and Holm adjustments. Among surveyed laboratories, 28.6% were in Lima and 71.4% in other regions. Lima hospitals were more likely to be Level III-2 institutions (50% vs. 3.3%). Structural gaps were common: only 26% had dedicated mycology areas, and more than half reported ≤ 20 m² of workspace. Lima laboratories tended to have larger facilities, more automated equipment, and more staff. Only 36% participated in external quality assessments, and 17% reported mycology training activities. Microscopy was widely available, but advanced tools were scarce: Polymerase Chain Reaction (PCR) was used in 4.8% of laboratories, and serology in one. No laboratory performed DNA sequencing. Mold identification relied primarily on morphology. In-vitro antifungal susceptibility testing was available in 43%, mostly for yeast, and access to key antifungals was inconsistent, with better availability in Lima. Substantial gaps in infrastructure, diagnostic capacity, training, and drug access, particularly outside Lima, underscore the need for strengthened mycology services to improve fungal disease diagnosis and care in Peru.