Delivering on Antimicrobial Resistance Agenda Not Possible without Improving Fungal Diagnostic Capabilities.

David W Denning,Eavan G Muldoon,David S Perlin,Tania C Sorrell,Arunaloke Chakrabarti,Arnaldo Lopes Colombo,Malcolm D Richardson

doi:10.3201/eid2302.152042

Abstract

Antimicrobial resistance, a major public health concern, largely arises from excess use of antibiotic and antifungal drugs. Lack of routine diagnostic testing for fungal diseases exacerbates the problem of antimicrobial drug empiricism, both antibiotic and antifungal. In support of this contention, we cite 4 common clinical situations that illustrate this problem: 1) inaccurate diagnosis of fungal sepsis in hospitals and intensive care units, resulting in inappropriate use of broad-spectrum antibacterial drugs in patients with invasive candidiasis; 2) failure to diagnose chronic pulmonary aspergillosis in patients with smear-negative pulmonary tuberculosis; 3) misdiagnosis of fungal asthma, resulting in unnecessary treatment with antibacterial drugs instead of antifungal drugs and missed diagnoses of life-threatening invasive aspergillosis in patients with chronic obstructive pulmonary disease; and 4) overtreatment and undertreatment of Pneumocystis pneumonia in HIV-positive patients. All communities should have access to nonculture fungal diagnostics, which can substantially benefit clinical outcome, antimicrobial stewardship, and control of antimicrobial resistance.

Highlights

Antimicrobial resistance, a major public health concern, largely arises from excess use of antibiotic and antifungal drugs
We provide 4 examples of specific clinical situations that require greater application of existing fungal diagnostics and improved overall fungal diagnostic capability and are in line with the 95–95 by 2025 Roadmap from the Global Action Fund for Fungal Infections [6]
Three well-validated diagnostic tools, 2 of which are configured for ruling out a diagnosis of invasive candidiasis, are available: the 1,3 β-D-glucan assay [19]; the Candida albicans germ tube antibody test, which is used with serum samples [20]; and a nonculture-based molecular assay that is used with EDTA blood and is substantially more sensitive than blood culture for making a diagnosis of Candida spp. infection [21]

Summary

Introduction

Antimicrobial resistance, a major public health concern, largely arises from excess use of antibiotic and antifungal drugs. Bloodstream infection and invasive candidiasis are substantially more common than realized and probably result from multiple factors, including unrestrained antibiotic drug use, indwelling devices, increasing populations of immunocompromised patients, and increased renal support.

Results

Conclusion