Preventive measures against antifungal resistant Aspergillus fumigatus strains: translating the fundamental microbiological approach into a socially feasible prevention model

Abstract

Fungal infections are a rising threat for human health with an annual causing up to 1.5 million deaths. While research has found a reasonable arsenal of antifungal compounds to combat the infections, emerging resistances against the compounds have alerted health institutes over the world. In 2022, the World Health Organisation (WHO) published its first report on the dangers of pathogens from the fungal kingdom in the form of a priority list. One of the four fungal species that were classified as critical priority is the opportunistic saprophyte Aspergillus fumigatus. The review utilises the emergence of azole-resistant A. fumigatus species as a framework. The overuse of azole-like fungicides has stimulated the development of cross-resistances with clinical antifungals, resulting in higher failure in therapies for invasive aspergillosis (IA) patients and increasing mortality rates. The ubiquity of the pathogen makes containment of spores nearly impossible, clearing the way for resistant strains to be inhaled by immunocompromised individuals. Increasing efforts in microbiological and pharmaceutical research and development may pave a way for novel antifungal compounds to be developed in the future. While these investments should not be thwarted or discouraged, combatting the threat requires more than increasing contributions of resources. Dual-use of antifungals in agriculture and clinics will eventually start the process over again. The WHO report mentioned it as well, the most effective manner of handling the threat is through large-scale regulation and monitoring of which antifungals are being used, what resistances are dominating in the atmosphere and where the strains firstly emerge. Introducing a global surveillance and regulatory project comes with struggles and organisational issues that surpass the scope of medical microbiology. Getting a majority of the world’s nations to commit to preservation of novel antifungals for clinical use and invest resources in surveillance and innovation requires the expertise of many different fields to propose an agreement that is effective and organisationally feasible.