Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 557-571 |
| Number of pages | 15 |
| Journal | Nature Reviews Microbiology |
| Volume | 20 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 29 Mar 2022 |
| Externally published | Yes |
Bibliographical note
Funding Information:M.C.F., D.C.S. and S.J.G. are fellows in the Canadian Institute for Advanced Research (CIFAR) ‘Fungal Kingdom’ programme. M.C.F. acknowledges funding from the Natural Environment Research Council (NERC) and the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK MRC and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement, and is also part of the EDCTP2 programme supported by the European Union. J.B. is supported by the Israel Science Foundation (#997/18) and European Research Council (ERC) Synergy Fungal Tolerance (#951475). A.W. and E.M.B. are supported by the MRC Centre for Medical Mycology (grant MR/N006364/2). S.J.G. is supported by the Biotechnology and Biological Sciences Research Council (BBSRC) (grant no. BB/PO18335) and the Bill and Melinda Gates Foundation. The contribution of B.Z. and P.E.V. is supported by the project ‘One health consequences of circularity. What lessons to learn from the saprophytic and human pathogenic fungus Aspergillus fumigatus ?’ (project number GROEN.2019.002), which is financed by the Dutch Research Council (NWO). The authors thank L. Schouls, Centre for Infectious Diseases Research, National Institute for Public Health and the Environment (RIVM), for comments. This Review was conceived as a result of the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) Strategic Research and Innovation Agenda (SRIA) update consultation.
Funding Information:
M.C.F., D.C.S. and S.J.G. are fellows in the Canadian Institute for Advanced Research (CIFAR) ‘Fungal Kingdom’ programme. M.C.F. acknowledges funding from the Natural Environment Research Council (NERC) and the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK MRC and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement, and is also part of the EDCTP2 programme supported by the European Union. J.B. is supported by the Israel Science Foundation (#997/18) and European Research Council (ERC) Synergy Fungal Tolerance (#951475). A.W. and E.M.B. are supported by the MRC Centre for Medical Mycology (grant MR/N006364/2). S.J.G. is supported by the Biotechnology and Biological Sciences Research Council (BBSRC) (grant no. BB/PO18335) and the Bill and Melinda Gates Foundation. The contribution of B.Z. and P.E.V. is supported by the project ‘One health consequences of circularity. What lessons to learn from the saprophytic and human pathogenic fungus Aspergillus fumigatus?’ (project number GROEN.2019.002), which is financed by the Dutch Research Council (NWO). The authors thank L. Schouls, Centre for Infectious Diseases Research, National Institute for Public Health and the Environment (RIVM), for comments. This Review was conceived as a result of the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) Strategic Research and Innovation Agenda (SRIA) update consultation.
Publisher Copyright:
© 2022, Springer Nature Limited.
Funding
M.C.F., D.C.S. and S.J.G. are fellows in the Canadian Institute for Advanced Research (CIFAR) ‘Fungal Kingdom’ programme. M.C.F. acknowledges funding from the Natural Environment Research Council (NERC) and the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK MRC and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement, and is also part of the EDCTP2 programme supported by the European Union. J.B. is supported by the Israel Science Foundation (#997/18) and European Research Council (ERC) Synergy Fungal Tolerance (#951475). A.W. and E.M.B. are supported by the MRC Centre for Medical Mycology (grant MR/N006364/2). S.J.G. is supported by the Biotechnology and Biological Sciences Research Council (BBSRC) (grant no. BB/PO18335) and the Bill and Melinda Gates Foundation. The contribution of B.Z. and P.E.V. is supported by the project ‘One health consequences of circularity. What lessons to learn from the saprophytic and human pathogenic fungus Aspergillus fumigatus ?’ (project number GROEN.2019.002), which is financed by the Dutch Research Council (NWO). The authors thank L. Schouls, Centre for Infectious Diseases Research, National Institute for Public Health and the Environment (RIVM), for comments. This Review was conceived as a result of the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) Strategic Research and Innovation Agenda (SRIA) update consultation. M.C.F., D.C.S. and S.J.G. are fellows in the Canadian Institute for Advanced Research (CIFAR) ‘Fungal Kingdom’ programme. M.C.F. acknowledges funding from the Natural Environment Research Council (NERC) and the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK MRC and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement, and is also part of the EDCTP2 programme supported by the European Union. J.B. is supported by the Israel Science Foundation (#997/18) and European Research Council (ERC) Synergy Fungal Tolerance (#951475). A.W. and E.M.B. are supported by the MRC Centre for Medical Mycology (grant MR/N006364/2). S.J.G. is supported by the Biotechnology and Biological Sciences Research Council (BBSRC) (grant no. BB/PO18335) and the Bill and Melinda Gates Foundation. The contribution of B.Z. and P.E.V. is supported by the project ‘One health consequences of circularity. What lessons to learn from the saprophytic and human pathogenic fungus Aspergillus fumigatus?’ (project number GROEN.2019.002), which is financed by the Dutch Research Council (NWO). The authors thank L. Schouls, Centre for Infectious Diseases Research, National Institute for Public Health and the Environment (RIVM), for comments. This Review was conceived as a result of the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) Strategic Research and Innovation Agenda (SRIA) update consultation.
