Impact of the use of azole fungicides, other than as human medicines, on the development of azole‐resistant Aspergillus spp.

The use of azoles in the European Union and European Economic Area (EU/EEA) for plant protection products has raised concerns about the emergence and spread of azole-resistant Aspergillus species. EU agencies and JRC reviewed evidence from 2010 to 2021, finding that around 120,000 tonnes of azoles were sold for non-human medicines, with the majority used for plant protection. Evidence showed a link between environmental azole exposure and cross-resistance selection to medical azoles in Aspergillus species, primarily for A. fumigatus. The prevalence of azole-resistant A. fumigatus in human infections ranges from 0.7% to 63.6%, with mortality rates ranging from 36% to 100% for invasive aspergillosis (IA). Recommendations were formulated to prevent and control azole resistance in A. fumigatus, including good agricultural practices, proper waste storage and management, and approval of new azole fungicides or renewal of existing ones.