Resistance to antifungal drugs increasing worldwide

A review led by experts at Imperial College London and the University of Exeter (Science 2018;360:739–42) has warned of the rising rate of emergence of pathogenic fungi that are resistant to commonly used antifungal agents and the consequent threat to human health worldwide.

The threat of antibiotic resistance has been much more widely publicised, but antifungal drug resistance should be of equal concern, because fungal infections have some of the highest mortality rates of infectious diseases. Those with an impaired immune system are most at risk of fungal infection, such as people with HIV, the elderly and hospitalised patients, and the number of patients in each of these populations continues to increase. The review authors warn of the risk of new multidrug-resistant fungi such as Candida auris, which is responsible for increasing rates of invasive fungal infections in hospitals worldwide, and which is now resistant to all clinical antifungals.

Part of the problem is the agricultural use of the same drugs that are used to treat fungal infections in the clinic, the authors note. Resistance to azole antifungals, which are used extensively in farming, is of particular concern, and multiazole-resistant Aspergillus fumigatus fungi have been recovered from environmental and clinical samples globally.

“To counter the escalating risks of fungal disease, we need to discover antifungal chemicals with new modes of action, hinder the emergence of resistance in extant chemicals by better stewardship, and develop new disease control strategies to avoid overreliance on fungicides,” the authors conclude.

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