While the global response to antimicrobial resistance (AMR) has largely focused on bacterial infections, a growing yet often overlooked threat is antifungal resistance. Fungal infections, which affect approximately 6.5 million people annually, are increasingly becoming resistant to the limited antifungal treatments available. Pathogens such as Candida auris and Aspergillus fumigatus have developed resistance to azoles, echinocandins, and other commonly used antifungals, making them harder to treat and leading to higher mortality rates.
One of the key challenges in combating antifungal resistance is the biological similarity between fungi and human cells, which makes developing antifungals without toxic side effects particularly difficult. Moreover, the agricultural use of fungicides that share mechanisms with medical antifungals exacerbates the issue by promoting cross-resistance. This is especially problematic with pathogens like Aspergillus fumigatus, which is commonly found in the environment and can become resistant to both agricultural and medical treatments.
Current diagnostic tools for fungal infections are also inadequate, particularly in low- and middle-income countries (LMICs), where disease burden is highest. Delayed diagnosis often leads to inappropriate use of antimicrobials, further driving resistance. The report emphasizes the need for better diagnostic capabilities, such as mass spectrometry and molecular testing, which are currently out of reach for many healthcare facilities.
The UN-hosted second high-level meeting on AMR in 2024 highlighted the need to address fungal resistance as part of the global AMR agenda. The report calls for increased investment in antifungal research and the development of new treatment options. It also advocates for collaboration across sectors—agriculture, healthcare, and pharmaceuticals—to address the growing threat of antifungal resistance. Without coordinated global action, fungal infections could become the next major hurdle in the fight against AMR.
Journal article: van Rhijn N, et al. 2024. Beyond Bacteria: The Growing Threat of Antifungal Resistance. The Lancet.
Summary by Faith Oluwamakinde
