It is no secret that antibiotic resistance, or antimicrobial resistance (AMR), is one of the top global public health and development threats. According to the World Health Organisation (WHO), bacterial AMR was directly responsible for 1.27 million global deaths in 2019, and contributed to another 4.95 million deaths that year.
While WHO and many other organizations are working on solutions, antimicrobial resistance is not a problem that is going away any time soon. To make matters worse, a renowned group of scientists has published a commentary saying we’re only considering half the problem.
In a commentary published in The Lancet this week, scientists at the University of Manchester, the Westerdijk Institute and the University of Amsterdam say the world’s focus on bacteria—specifically—is not enough. They warn that fungal pathogens must also be taken into consideration in the fight against resistance. In fact, most fungal pathogens identified by WHO—which account for around 3.8 million deaths a year by themselves—are either already resistant or rapidly acquiring resistance to antifungal drugs.
Fungicide-resistant infections
Resistance is now the “norm”—rather than the exception—for the four currently available antifungal classes, making it difficult, if not impossible, to treat many invasive fungal infections. Fungicide-resistant infections like Aspergillus, Candida, Nakaseomyces glabratus, and Trichophyton indotineae can all have devastating health impacts on older or immunocompromised people.
“Most people agree that resistant bacterial infections constitute a significant part of the AMR problem. However, many drug resistance problems over the past decades have also been the result of invasive fungal diseases largely underrecognized by scientists, governments, clinicians and pharmaceutical companies. The threat of fungal pathogens and antifungal resistance, even though it is a growing global issue, is being left out of the debate,” said author Norman van Rhijn from the University of Manchester.
Unlike bacteria, the close similarities between fungal and human cells means it is hard to find treatments that selectively inhibit fungi with minimal toxicity to patients. Additionally, the scientists say potential treatments are often preempted by the agrochemical industry.
“Several promising new agents, including entirely new classes of molecules, have entered clinical trials in recent years. But even before they reach the market after years of development, fungicides with similar modes of action are developed by the agrochemical industry, resulting in cross-resistance,” said Ferry Hagen, group leader at the Westerdijk Fungal Biodiversity Institute in The Netherlands. “This sets us back to square one again. It is true many essential crops are affected by fungi, so antifungal protection is required for food security. But the question is, at what price?”
Thus, in their commentary, Hagen, van Rhijn and others recommend worldwide agreement on the restriction of certain classes of antifungal molecules for specific applications, such as agriculture. They also suggest collaboration on solutions and regulations that ensure food security and health for animals, plants and humans alike. Lastly, the authors demand September’s United Nations meeting on antimicrobial resistance include discussion and solutions for fungal pathogens—in addition to bacteria.