Abstract
The recent rate of emergence of pathogenic fungi that are resistant to the limited number of commonly used antifungal agents is unprecedented. The azoles, for example, are used not only for human and animal health care and crop protection but also in antifouling coatings and timber preservation. The ubiquity and multiple uses of azoles have hastened the independent evolution of resistance in many environments. One consequence is an increasing risk in human health care from naturally occurring opportunistic fungal pathogens that have acquired resistance to this broad class of chemicals. To avoid a global collapse in our ability to control fungal infections and to avoid critical failures in medicine and food security, we must improve our stewardship of extant chemicals, promote new antifungal discovery, and leverage emerging technologies for alternative solutions.
Highlights
Antifungals for the treatment of fungal diseases in the clinic and the field The chemical control of fungal pathogens that cause diseases in animals and crops has progressed from the use of inorganic chemicals to the use of organic surface protectant chemicals and to the use of systemically acting fungicides
The global movement of people and global trade in produce have hastened the free flow of fungal pathogens from country to country, bringing pathogens into contact with naïve hosts [1] (Fig. 3)
The emergence of resistance in Candida glabrata has coincided with this species becoming the predominant bloodstream pathogen recovered from patients, largely because of the increasing prophylactic use of echinocandins and azoles [7]
Summary
Worldwide emergence of resistance to antifungal drugs challenges human health and food security. The rapid emergence of multidrug-resistant pathogenic fungi and the better-publicized threat of antibiotic-resistant bacteria together pose a considerable threat to disease control across diverse anthropogenic systems. These microbes respond adroitly to human-induced natural selection through chemical treatments and nimbly hijack human globalization pathways [1], disseminating the problems worldwide. Resistance of clinical pathogens to all licensed systemic antifungals has been documented, the rate of emergence varies among drug classes (Fig. 1) [3]. Despite the wider range of fungicides licensed for use in agriculture, resistance to each main class of fungicides has emerged in some major pathogens (Fig. 1). The azoles remain the dominant chemicals in the treatment of fungal infections in crops, humans, and livestock, with five licensed clinical azole antifungals and 31 available for crop protection
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