Tackling the emerging threat of antifungal resistance to human health

Invasive fungal infections pose an important threat to public health and are an under-recognized component of antimicrobial resistance, an emerging crisis worldwide. Across a period of profound global environmental change and expanding at-risk populations, human-infecting pathogenic fungi are evolving resistance to all licensed systemic antifungal drugs. In this Review, we highlight the main mechanisms of antifungal resistance and explore the similarities and differences between bacterial and fungal resistance to antimicrobial control. We discuss the research and innovation topics that are needed for risk reduction strategies aimed at minimizing the emergence of resistance in pathogenic fungi. These topics include links between the environment and One Health, surveillance, diagnostics, routes of transmission, novel therapeutics and methods to mitigate hotspots for fungal adaptation. We emphasize the global efforts required to steward our existing antifungal armamentarium, and to direct the research and development of future therapies and interventions. The impacts of fungal infections on human health are of increasing concern, and resistance of pathogenic fungi to all licensed systemic antifungals has been documented. In this Review, Fisher, Verweij and colleagues discuss the research and innovation topics that are needed to understand and minimize the occurrence and impact of antifungal resistance.

Automated summary

This review emphasizes the important threat of invasive fungal infections to public health and the emergence of antifungal resistance. It discusses the main mechanisms of antifungal resistance and compares them with bacterial resistance to antimicrobial control. The review also explores the research and innovation topics needed to minimize the occurrence and impact of antifungal resistance, including environmental links, surveillance, diagnostics, transmission routes, novel therapeutics, and hotspot mitigation strategies. The need for global efforts to manage existing antifungal drugs and direct future research and development of therapies and interventions is highlighted.