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Abstract Antifungal stewardship (AFS) programs are key to optimize antifungal use and improve outcomes in patients with invasive fungal infections. Our systematic literature review evaluated the impact of diagnostics in AFS programs by assessing performance and clinical measures. Most eligible studies were from Europe and US (n = 12/17). Diagnostic approaches included serum β-1–3-D-glucan test (n/N studies, 7/17), galactomannan test (4/17), CT scan (3/17), magnetic resonance (2/17), MALDI-TOF MS (2/17), PCR (1/17), PNA-FISH assay (1/17), and other routine methods (9/17). Time to species identification reduced significantly using MALDI-TOF and PNA FISH (n = 2). Time to targeted therapy and length of empiric therapy also decreased (n = 3). Antifungal consumption reduced by 11.6%-59.0% (7/13). Cost-savings ranged from 13.5%-50.6% (5/10). Mortality rate (13/16) and length of stay (6/7) also reduced. No negative impact reported on patient outcomes. Diagnostics-driven interventions can potentially improve AFS measures (antifungal consumption, cost, mortality, and LOS), therefore AFS implementation should be encouraged.