Global mycology community calls to combat drug‑resistant fungi

Fifty researchers from across the world have joined forces to create a new five-step plan to protect vulnerable patients from the health risks caused by fungi becoming resistant to drugs.

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.

Now, fifty researchers from sixteen organizations have gathered global data and developed a five‑step plan published in Nature Medicine, to better monitor and prevent the rise of resistant fungi. The publication 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 Co-authors of the publication include experts from the University of Exeter’s Medical Research Council-Centre for Medical Mycology: Professors Elaine Bignell, Gordon Brown, Neil Gow and Adilia Warris.

Professor Neil Gow said: ”We are seeing a steady and worrying rise in the numbers of drug-resistant strains of fungal pathogens as well as the emergence of new drug resistant fungal species. This is no longer an issue that is restricted to bacteriologists, virologists and parasitologists – fungal antimicrobial resistance is a clear and growing concern that requires urgent attention.”

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, Candidozyma 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, where resistance to azoles is found globally and compromises our treatment options.

Antifungal resistance does not develop in hospitals but mainly in the environment. The fungicides used to protect crops against fungal plant diseases closely resemble the antifungal drugs used in healthcare. Their use in agriculture allows fungi to develop resistance to these agents. As a result, resistance emerging in agriculture can lead to less effective treatments for patients with severe fungal infections. The use of antifungal compounds for different applications underscores the interconnection between environment, veterinary medicine and human medicine, also called One Health.

Professor Paul E. Verweij, consultant microbiologist at the Radboud University Medical Centre Nijmegen, the Netherlands and lead author. “We are facing a silent surge of drug‑resistant fungi—from Candida auris in intensive care units 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

Multiple actions needed

To safeguard both global food security and maintain effective treatments of fungal diseases, multidisciplinary and multisectoral collaborations are needed including scientists from different backgrounds, stakeholders and policymakers. Some initiatives to facilitate One Health interventions are being taken, including the WHO fungal priority pathogen list blueprint plan which describes which steps are needed to curb antifungal resistance and the establishment of One Health working groups at the leading international mycology societies. However, these initiatives need to be embedded in global AMR policies. The global mycology community now reaches out to prioritize antifungal resistance within these policies and to take necessary actions.

Professor Adilia Warris said: ”Optimal management for invasive fungal diseases is severely compromised by the emergence of antifungal resistance and is resulting in poor patient outcomes. Due to the dual use of antifungals in the environment and the clinic, with only a few antifungal classes available for clinical use, we need to ensure to use our minimal antifungal armamentarium in the best possible way.

“To safeguard both global food security and maintain effective treatments of fungal diseases, we need multidisciplinary and multisectoral collaboration, including scientists from different backgrounds, stakeholders and policymakers. We urgently need initiatives to be embedded in global AMR policies. Everyone needs to work together to take action now.” The commentary is titled ‘Closing the Gap on Antifungal Resistance’ and is published in Nature Medicine