As for other microorganisms that infect humans, drug resistance has long been recognized in fungi of medical importance, such as Candida and Aspergillus spp. Fungi tend to get less publicity than bacteria and viruses – perhaps because invasive (systemic) fungal infections are of most concern for special populations like hospitalized and immunocompromised people. However, a recent Dutch report documents the high mortality of such infections.

Some features of fungi and of antifungal medicines make them especially fascinating “One Health” examples of resistance, and potentially fruitful research topics. In particular, currently there are just a few classes of antifungal agents with just a few mechanisms of action, and – as highlighted in a recent Science article – these are used across human and veterinary medicine, in agriculture for crop protection, and for other environmental purposes such as preservation of wooden structures. This widespread use encourages development and spread of antifungal resistance.

On the clinical front, a Lancet Infectious Diseases review neatly summarized “[t]he global problem of antifungal resistance: prevalence, mechanisms, and management.” Antifungal stewardship (AFS) programmes are attracting attention, and a newly published report on such an effort in a London hospital found that specialist guidance “to optimize antifungal prescribing resulted in significant cost savings without compromising on microbiological or clinical outcomes.” Quicker diagnostic tests for fungi, novel drugs and possibly repurposing of existing agents are the focus of current R&D.