Beyond bacteria: the growing threat of antifungal resistance

Resistant bacterial infections are a significant part of the Antimicrobial Resistance (AMR) problem, but they are often overlooked in efforts to combat AMR. The WHO published the Fungal Priority Pathogen List (FPPL) in 2022 to highlight the need to combat fungal diseases, which affect 6.5 million people annually and account for 30.8 million deaths. Many of the WHO FPPL pathogens are intrinsically resistant to current systemic antifungal agents or rapidly acquire resistance upon exposure.

Despite the WHO FPPL’s primary purpose, the desired effect has not been fully achieved, with only five sentences in one of the four Series papers devoted to a few fungal pathogens. Combating fungal infections and antifungal resistance is a complex problem, with diagnosis often delayed or difficult, increasing the risk of resistance emergence in vivo.

Antifungal drug development is hampered by the close similarities between fungal and human cells, making it difficult to find compounds that selectively inhibit fungi with minimal toxicity to the patient. Despite this, several promising new agents have entered clinical trials in the past decade. However, fungicides with similar modes of action are developed by the agrochemical industry, resulting in cross-resistance for critical priority pathogens like A fumigatus.