Antimicrobial resistance (AMR) is in the international spotlight. But conversation has so far been dominated by antibiotics, leaving an important facet often overlooked: antifungal resistance (AFR).^1,2
 

Fungal pathogens are already responsible for more than 150 million cases of severe infections, resulting in approximately 1.7 million deaths globally per year.³ Without immediate stewardship action, this figure will only increase.

FUNGI IN FOCUS
 

Fungal infections are caused by either yeast or mould. Fungal pathogens Candida, Aspergillus, and Cryptococcus species are responsible for some of the world’s most serious fungal infections.^4,5

Invasive fungal infections (IFIs) mainly affect people who are immunocompromised or

immunosuppressed, particularly because of chemotherapy, organ transplants, or chronic

respiratory disease.²


INFORMATION IS AMMUNITION 

Over a period of profound global environmental change, human-infecting pathogenic fungi are evolving resistance to all licensed systemic antifungal medicines.⁶
 

Even more concerning, the fight against AFR has a limited arsenal.^5,6 Traditionally, treatment

relies on just four main classes of antifungal drugs (azoles, echinocandins, polyenes, and

pyrimidine analogue 5-flucytosine), with the newest class (echinocandins) introduced over 20 years ago.^1,5,6
 

Resistance to azoles in particular is an emerging therapeutic challenge. Azoles are widely used in agriculture due to their broad-spectrum activity and low cost. Now, azole resistance is more commonly acquired through environmental exposure than during azole therapy.^7–10
 

Despite growing concerns, fungal infections receive very little attention and resources.² If we are to stop the proliferation of AMR as a whole, we need effective antifungal stewardship now.⁶
 

It’s important we shine a light on the dangers of IFIs. We have a long and proud heritage of

addressing infectious disease challenges, and our strategic investments in antifungal R&D will ensure we can continue this fight in the future.^11–13


KNOW THE FOE

In 2022, World Health Organization (WHO) published the first-ever list of fungal priority

pathogens.^1,2 Inspired by the well-established equivalent bacterial list, this report focuses on

infection-causing fungi with ongoing resistance or management challenges. The 19 pathogens included were ranked based on the level of threat to public health, and they were categorized as critical, high, or medium priority.^1,2
 

Policymakers and health professionals should take note of three key actions recommended

by WHO:²

1. Strengthen laboratory capacity and surveillance
2. Support research, development, and innovation investments
3. Enhance public health interventions for prevention and control

With the publication of this ground-breaking document, WHO have made their position clear:

AFR needs to be taken seriously.
 

We have a long way to go to stop the development of further AFR, but knowledge of the priority pathogen list will help the fight against fungi in the future.