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The rapid emergence of antifungal-resistant human-pathogenic fungi

Nature Reviews Microbiology volume 21, pages 818–832 (2023)Cite this article

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Abstract

During recent decades, the emergence of pathogenic fungi has posed an increasing public health threat, particularly given the limited number of antifungal drugs available to treat invasive infections. In this Review, we discuss the global emergence and spread of three emerging antifungal-resistant fungi: Candida auris, driven by global health-care transmission and possibly facilitated by climate change; azole-resistant Aspergillus fumigatus, driven by the selection facilitated by azole fungicide use in agricultural and other settings; and Trichophyton indotineae, driven by the under-regulated use of over-the-counter high-potency corticosteroid-containing antifungal creams. The diversity of the fungi themselves and the drivers of their emergence make it clear that we cannot predict what might emerge next. Therefore, vigilance is critical to monitoring fungal emergence, as well as the rise in overall antifungal resistance.

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Fig. 1: Global distribution of the three emerging fungi Candida auris, azole-resistant Aspergillus fumigatus and Trichophyton indotineae.
Fig. 2: The more common mechanisms of acquired antifungal resistance of Candida auris.
Fig. 3: Possible routes of acquisition of antifungal-resistant Aspergillus fumigatus.
Fig. 4: Mechanisms of acquired resistance of azole-resistant Aspergillus fumigatus.
Fig. 5: Mechanisms of acquired resistance of Trichophyton indotineae.

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Acknowledgements

The authors acknowledge M. McCloskey for her assistance with data collection. A.C. is a fellow of the CIFAR programme Fungal Kingdom: Threats & Opportunities.

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Authors and Affiliations

  1. Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Shawn R. Lockhart & Jeremy A. W. Gold

  2. Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

    Anuradha Chowdhary

  3. National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Medical Mycology Unit, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

    Anuradha Chowdhary

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CDC Infection Prevention and Control for Candida auris: https://www.cdc.gov/fungal/candida-auris/c-auris-infection-control.html

Centers for Disease Control and Prevention antimicrobial-resistant Aspergillus: https://www.cdc.gov/fungal/diseases/aspergillosis/antifungal-resistant.html

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Lockhart, S.R., Chowdhary, A. & Gold, J.A.W. The rapid emergence of antifungal-resistant human-pathogenic fungi. Nat Rev Microbiol 21, 818–832 (2023). https://doi.org/10.1038/s41579-023-00960-9

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