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Access to the appropriate tools is crucial for early diagnosis and clinical management of invasive fungal infections. This Review aims to describe the invasive fungal infection diagnostic capacity of Europe to better understand the status and the most pressing aspects that need improvement. To our knowledge, this is the first time that the mycological diagnostic capability and access to antifungal treatments of institutions has been evaluated at a pan-European level. Between Nov 1, 2021, and Jan 31, 2022, 388 institutions in Europe self-assessed their invasive fungal infection management capability. Of the 388 participating institutions from 45 countries, 383 (99%) had access to cultures, 375 (97%) to microscopy, 363 (94%) to antigen-detection assays, 329 (85%) to molecular tests (mostly PCR), and 324 (84%) to antibody tests for diagnosis and management. With the exception of microscopy, there were considerable differences in access to techniques among countries according to their gross domestic product. At least one triazole was available in 363 (94%) of the institutions, one echinocandin in 346 (89%), and liposomal amphotericin B in 301 (78%), with country gross domestic product-based differences. Differences were also observed in the access to therapeutic drug monitoring. Although Europe is well prepared to manage invasive fungal infections, some institutions do not have access to certain diagnostic tools and antifungal drugs, despite most being considered essential by WHO. These limitations need to be overcome to ensure that all patients receive the best diagnostic and therapeutic management., Competing Interests: Declaration of interests JS-G received payments or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead and Pfizer, outside of the submitted work. MH received grants or contracts from Gilead, Pfizer, Astellas, Euroimmune, MSD, Pulmocide, Scynexis, and F2G, outside of the submitted work. J-PG received grants or contracts from Pfizer, and consulting fees from Gilead and Pfizer, outside of the submitted work. AA-I received payments or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead and Pfizer; received support for attending meetings and travel from Gilead; participated on a data safety monitoring board or advisory board for JPI-AMR; and had a leadership or fiduciary role in board, society, committee or advocacy groups that were either paid or unpaid, from WHO, European Society of Clinical Microbiology and Infectious Diseases, Fungal Infection Study Group, and Global Action For Fungal Infections, outside of the submitted work. KL received grants or contracts from Thermo Fisher Scientific and TECOmedical; consulting fees from Gilead, MSD, and MRM Health; and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Pfizer, Gilead, and FUJIFILM Wako, outside of the submitted work. SAA reports grants or contracts from Cidara; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead; and support for attending meetings and travel from Astellas, outside of the submitted work. VÖ received grants or contracts from International Health Management Associates and Sentry, outside of the submitted work. OAC received grants or contracts from Amplyx, Basilea, Bundesministerium für Bildung und Forschung, Cidara, Deutsches Zentrum für Infektionsforschung, EU Directorate-General for Research and Innovation (grant: 101037867), F2G, Gilead, Matinas, MedPace, MSD, Mundipharma, Octapharma, Pfizer, and Scynexis; consulting fees from AbbVie, Amplyx, Biocon, Biosys, Cidara, Da Volterra, Gilead, Matinas, MedPace, Menarini, Molecular Partners, Mycoses Study Group Education and Research Consortium (MSG-ERC), Noxxon, Octapharma, Pardes, PSI, Scynexis, and Seres; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Abbott, Al-Jazeera Pharmaceuticals, Astellas, Grupo Biotoscana/United Medical/Knight, Hikma, MedScape, MedUpdate, Merck-MSD, Mylan, and Pfizer; payment for expert testimony from Cidara; patents planned, issued, or pending from the German Patent and Trademark Office; participation on a data safety monitoring board or advisory board for Actelion, Allecra, Cidara, Entasis, IQVIA, Janssen, MedPace, Paratek, PSI, Pulmocide, and Shionogi; and other financial or non-financial interests from Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie, Deutsche Gesellschaft für Information und Wissen, European Confederation of Medical Mycology, International Society for Human and Animal Mycology, MSG-ERC, and Wiley, outside of the submitted work. ES and AV declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)