Antifungal Resistance: Challenges in Diagnosis and Management

Dear Colleagues,

Antifungal resistance is one of the most pressing healthcare challenges of our time. Resistance can develop in parallel across geographical barriers and is spreading worldwide. In recent years, healthcare workers have been increasingly burdened by invasive, difficult-to-treat infections targeting vulnerable populations, namely the abrupt global surge of Candida auris, an opportunistic infection that is typically resistant to one or multiple standard antifungals with the ability to thrive on the skin and hospital surfaces, and the epidemic Trichophyton indotineae, a newly evolved strain causing unusually severe and extensive tineas with terbinafine resistance.

Continued research efforts have been directed to improve the diagnosis and management of resistant mycoses. While the expansion of molecular diagnostics has enabled healthcare providers to identify fungal infections with increased precision, there remain issues of access and uptake that impede surveillance efforts. Antifungal stewardship is being increasingly advocated to preserve our already-limited number of treatment options. However, predicting treatment resistance requires antifungal susceptibility testing, which is subject to methodological variations and a lack of reference breakpoints, which complicate clinical decision-making.

It is apparent that the epidemiology of fungal infections is evolving, which has been linked to climate change altering membrane physiology and thermal tolerance, zoonotic transmission seeding new outbreaks, and dual-use antifungals in the agriculture sector exacerbating azole resistance. In response, the global community has advocated for One Health, an integrated collaborative framework spanning human health, animal health, and environmental health. We hope that with these collaborations, we will find innovative solutions to tackle the antifungal resistance problem.

Prof. Dr. Aditya K. Gupta
Guest Editor

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