Antifungal resistance, which sees fungi develop the ability to survive treatment after causing an infection, is a growing threat to human health. It is estimated that fungal infections which can impact the lungs, brain, bloodstream and skin could contribute to more than 3.8 million deaths each year.
Calling for urgent action to stop fungal infections becoming untreatable, an international group of 50 researchers have published a warning in Nature Medicine that drug resistant fungi are spreading fast and putting vulnerable patients at growing risk.
The scientists say that fungi in soil, crops and hospitals are increasingly resistant to treatments used to control them.
“Coordinated action across science, farming, healthcare and policy is now essential to protect both global food supplies and patient safety,” the piece warns.
The researchers argue that global strategies to tackle antimicrobial resistance have focused too heavily on bacteria and viruses, while largely overlooking fungi. They say that several dangerous fungi are already spreading, including Trichophyton indotineae, which causes severe skin infections that are increasingly hard treat. Hospitals as also battling Candida auris, a fungus that can trigger life-threatening bloodstream infections - and kills around a third of those infected.
The researchers add that much of the resistance begins not in hospitals but in the environment. Fungicides used in agriculture are chemically similar to antifungal medicines used in human healthcare, so resistant strains can evolve in fields before reaching patients.
“Farmers use huge amounts of fungicides to protect crops, and some of these chemicals stay in the environment for decades,” said Professor Mike Bromley, of the University of Manchester. “There is now clear evidence these chemicals are helping fungi evolve into strains that can no longer be treated in people, plants or animals.”
To help address the issues, the researchers have produced a five-step plan to improve awareness, surveillance, infection control, responsible drug use and investment in new treatments. Bromley added: “If we don’t act, we will see more infections that simply cannot be cured which puts lives and food supplies at risk.”
Professor Paul Verweij from Radboud University Medical Centre in the Netherlands added: “Unless antifungal resistance is included in the WHO’s 2026 global plan with proper funding targets, we risk repeating the same mistakes made with antibiotic resistance.”
“Using the same types of antifungal chemicals in both farming and medicine is speeding up resistance, and what happens in the fields is now affecting what happens in hospital wards,” added Professor Michaela Lackner of the Medical University of Innsbruck.
With only four major classes of antifungal drugs in clinical use, the options for treating fungal infections are limited, so there is an urgent need to develop new antifungal therapies.
But developing these therapies is challenging as fungal cells are biologically similar to human cells. To address these issues, the Ineos Oxford Institute for antimicrobial research (IOI) has established an antifungal drug discovery programme. This programme will combine microbial ecology, synthetic biology and medicinal chemistry to uncover new antifungal agents and develop next-generation antifungal therapies that are more resilient to resistance. The programme also expands the institute's efforts to address the full spectrum of drug-resistant infections and accelerate the development of therapies which are urgently needed.
Dr Xuefei Chen, programme leader said: “Fungal resistance is limiting treatment options for humans and affecting animals and food crops, yet it remains one of the least studied areas of antimicrobial resistance research.” The antifungal programme will establish a pipeline for discovering, optimising and advancing new antifungal treatments towards clinical use.
“We need to treat infectious fungi with the same urgency as disease causing bacteria. The limited number of antifungal drugs that currently exist are starting to fail, and we need to build capacity in fungal research,” said Professor Kevin Pethe, director of the Ineos Oxford Institute for antimicrobial research.
Further reading:
- Critical lack of medicines for invasive fungal diseases, warns WHO
- WHO sets out first ever list of fungal pathogens of concern
- What is AMR? Here’s what you need to know about antimicrobial resistance
- An amoeba is at the heart of this new bio-fungicide
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