Institutional preparedness for invasive fungal infections in the Nordic healthcare landscape: A survey from the Nordic Society for Medical Mycology (NSMM), the European Confederation of Medical Mycology (ECMM), and the ESCMID Fungal Infection Study Group (EFISG)

Volkan Özenci¹Nahid Kondori²Ingvild Nordøy³Cecilie Torp Andersen³Marianna Konoy⁴Maiken Cavling Arendrup⁵Nathalie Friberg⁶Ingibjörg Hilmarsdóttir⁷Oliver A. Cornely⁸Jon Salmanton-Garcia^9*

• ¹Karolinska Institutet Avdelningen for Klinisk mikrobiologi, Huddinge, Sweden
• ²Goteborgs universitet Sahlgrenska Akademin, Gothenburg, Sweden
• ³Oslo universitetssykehus Rikshospitalet, Oslo, Norway
• ⁴Frodskaparsetur Foroya, Tórshavn, Faroe Islands
• ⁵Statens Serum Institut, Copenhagen, Denmark
• ⁶Helsingin yliopisto Helsinki Institute of Life Sciences, Helsinki, Finland
• ⁷Landspitali Erfda- og sameindalaeknisfraedideild, Reykjavík, Iceland
• ⁸Universitatsklinikum Koln, Cologne, Germany
• ⁹University Hospital of Cologne, Cologne, Germany

Introduction Invasive fungal diseases (IFD) cause substantial morbidity and mortality in immunocompromised patients and present increasing challenges due to expanding at-risk populations and emerging antifungal resistance. Despite well-developed healthcare systems, the Nordic countries yet face challenges in managing IFD due to decentralized care delivery and demographic shifts. Data on institutional preparedness for IFD management in this region remain scarce. Methods We conducted a multicentre, questionnaire-based survey from October 2021 to April 2023 assessing diagnostic and therapeutic capacity for IFD across tertiary care centres in Denmark, Finland, Iceland, Norway, and Sweden. The survey evaluated diagnostic infrastructure, fungal pathogen awareness, antifungal drug availability, and therapeutic drug monitoring (TDM). Results A total of 35 centres took part in the survey. Overall, IFD incidence was perceived as low. Candida spp. and Aspergillus spp. stood out as the key fungal threats across all sites. Diagnostic tools were widespread — microscopy was in use at 94% of centres, while culture, MALDI-TOF MS, and PCR each reached 97%, though some regional differences remained. On the treatment side, frontline antifungals like azoles, echinocandins, and liposomal amphotericin B were universally available (100% of centres). However, flucytosine access was more limited, offered at under half of the centres (48%). TDM was reliably accessible in 86% of locations. Advanced imaging techniques such as PET-CT and PET-MRI showed restricted access, with availability at 60% and 20% of centres, respectively. Conclusion Nordic tertiary care centres demonstrate generally strong preparedness for IFD management, yet targeted improvements are needed in molecular diagnostics, flucytosine availability, therapeutic drug monitoring, and advanced imaging. Addressing these gaps through coordinated policy and resource allocation may improve outcomes for vulnerable patients and serve as a model for other high-income regions with decentralized healthcare structures.