An increasing number of fungi are becoming resistant to medication, posing serious risks for patients with weakened immune systems. That is why fifty researchers from around the world, led by Radboudumc, are calling for action against drug‑resistant fungi. Their call has been published in Nature Medicine.
Fungi in our environment are increasingly resistant to antifungal drugs. For healthy people this usually causes no problems, but for those with weakened immunity these fungi can lead to severe infections. Growing resistance makes treatment much more difficult. While global strategies against antimicrobial resistance have long focused mainly on bacteria and viruses, there is urgent need to give fungi more attention.
Five‑step plan
Under the leadership of Paul Verweij, medical microbiologist and professor at Radboudumc, fifty researchers from sixteen organizations worked together. They gathered global data and developed a five‑step plan to better monitor and prevent the rise of resistant fungi. The publication in Nature Medicine is an important stepping stone towards the update of the World Health Organization’s (WHO) Global Action Plan later this year. This call to action is needed because fungal resistance still receives too little attention in current approaches. The five steps include awareness, surveillance, infection prevention and control, optimized use, and investments
Fungi are everywhere
Various fungi can cause infections. Skin fungi usually lead to mild conditions such as athlete’s foot or nail fungus. But increasingly, persistent and drug‑resistant species are emerging, such as Trichophyton indotineae, which can cause severe and difficult-to-treat skin infections. In hospitals, Candida auris poses an even greater risk, as it can cause serious bloodstream infections in vulnerable patients. One in three patients with this infection does not survive. Aspergillus fumigatus is also a concern. ‘We inhale this fungus, and it can severely damage the lungs’, Verweij explains. ‘In recent years we have seen it more often in ICUs, for example in people with influenza.’
Fungal resistance does not develop in hospitals but originates largely in the environment. Fungicides used to protect crops against fungal plant diseases closely resemble the antifungal drugs used in healthcare. Long‑term exposure in agriculture allows fungi to develop resistance to these agents. These resistant fungi then spread through the air. As a result, resistance emerging in agriculture can lead to less effective treatments for patients with severe fungal infections. The widespread use of antifungal compounds across different sectors highlights the need for an integrated, or “One Health”, approach.
Few new medications
Developing new antifungal drugs is challenging. The cell structure of fungi is very similar to that of humans, much more than in bacteria. This means that antifungal drugs can also damage human cells, causing significant side effects. ‘That’s why only five new classes of antifungal drugs have been developed in the past 75 years’, says Verweij.
Because so few new medications are becoming available, preventing resistance is crucial. ‘We need more data and evidence on fungal infections and antifungal resistance to inform and improve response to these priority fungal pathogens’, says Haileyesus Getahun, director of the WHO program for global coordination on antimicrobial resistance. With their new five‑step plan, Verweij and his colleagues hope countries around the world will be better prepared for this growing threat.
About the publication
This research is published in Nature Medicine: Closing the Gap on Antifungal Resistance.
PE Verweij, A Alastruey‑Izquierdo, K Amilon, MC Arendrup, D Armstrong‑James, E Bignell, DR Boulware, J Brandão, M Bromley, GD Brown, JB Buil, A Chakrabarti, M Chayakulkeeree, T Chiller, A Chindamporn, AL Colombo, OA Cornely, E Dannaoui, PJ Dufresne, A Forastiero, J Gangneux, C Giske, NP Govender, NAR Gow, J Guillot, T Harrison, M Hoenigl, DP Kontoyiannis, C Lass‑Flörl, T Le, R Li, N Medina, JF Meis, J Meletiadis, RO Oladele, L Ostrosky‑Zeichner, AK Patel, JR Perfect, F Queiroz‑Telles, JL Rodriguez‑Tudela, SM Rudramurthy, J Salmanton‑García, AR dos Santos, E Segal, A Seyedmousavi, Y Song, GR Thompson, A Vena, A Warris, NP Wiederhold, M Lackner. DOI: 10.1038/s41591-026-04334-5.
Quotes
'We are facing a silent surge of drug‑resistant fungi – from Candida auris in ICUs to azole‑resistant Aspergillus in the community – that is already costing lives. Antifungal resistance must be integrated into the 2026 Global Action Plan on AMR, with concrete milestones and funding, or we risk repeating the mistakes made with antibacterial resistance', said Professor Paul E. Verweij, consultant microbiologist at Radboudumc.
'Dual use of antifungal targets in medicine and agriculture is accelerating resistance from fields to ICUs. Aligning agricultural authorizations with health risk assessments, while investing in new antifungals and affordable diagnostics, is a pragmatic One Health solution that protects both food security and patient care', said Professor Michaela Lackner, microbiologist at Medical University of Innsbruck.
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