Scientists issue call to arms over antifungal resistance

Infectious disease experts from around the world are calling for concerted action to combat a "silent surge" in resistance to mainstay antifungal drugs.

Writing in the journal Nature Medicine, the group of more than 50 researchers contend there is an urgent need to give fungal resistance greater attention in global strategies against antimicrobial resistance (AMR), which focus mainly on bacterial and viral infections.

Led by Paul Verweij of Radboud University Medical Centre (Radboudumc) in the Netherlands, the experts have developed a five‑step plan to better monitor and prevent the rise of resistant fungi, hoping to influence a planned update to the WHO's decade-old Global Action Plan on AMR later this year.

The action is needed because fungal resistance still receives too little attention in current approaches, according to the authors, whose plan focuses on raising awareness, improving surveillance, infection prevention and control, optimised use of current antifungal therapies, and ramped-up investment in new diagnostics and medicines.

The latter should include support for pragmatic trials, technology transfer, and local manufacturing, particularly in low- and middle-income countries (LMICs).

"We are facing a silent surge of drug‑resistant fungi – from Candida auris in [intensive care units] to azole‑resistant Aspergillus in the community – that is already costing lives," said Verweij.

Invasive fungal diseases affect over 6.5 million people annually and carry high mortality rates, even when pathogens are susceptible to antifungal medications, and the rise of drug-resistant yeasts and moulds is exacerbating the problem, according to the paper.

Candida auris can cause serious bloodstream infections in vulnerable patients, like those with compromised immunity, for example, and one in three patients who develop the infection do not survive. Another rising concern is Aspergillus fumigatus, an inhaled infection that is being seen more often in the OCU, particularly in people with severe influenza.

"Antifungal resistance must be integrated into the 2026 Global Action Plan on AMR, with concrete milestones and funding, or we risk repeating the mistakes made with antibacterial resistance," continued Verweij.

Another expert, Professor Michaela Lackner, of the Medical University of Innsbruck in Austria, highlighted the dual use of antifungal targets in medicine and agriculture, which is "accelerating resistance from fields to ICU."

The authors would like to see "near-term milestones, equitable financing, and […] stewardship that integrates clinical, agricultural and environmental policies" in the plan.

Thanks to a widespread retreat by the pharma industry in the last few decades, there have only been a handful of new antifungal agents introduced onto the market since the WHO's action plan was first drawn up in 2015, with recent launches including Cidara/Melinta's Rezzayo (rezafungin) in 2023, Mycovia Pharma's Vivjoa (oteseconazole) in 2022, and GSK/Scynexis's Brexafemme (ibrexafungerp) in 2021.

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