Antimicrobial-Resistant Fungal Diseases

At a glance

Antimicrobial-resistant fungal diseases are increasing worldwide. With three classes of antifungals available, these infections can be difficult, sometimes impossible to treat. CDC supports initiatives worldwide to stop the emergence of AR. Appropriate use of antifungals in human and animal medicine, and in the environment helps keep medications working.

The problem

Antimicrobial-resistant fungal infections are increasing throughout the world as more resistant fungi are emerging.

Antimicrobial resistance (AR) happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. This includes antifungals, the type of antimicrobials that treat fungal infections.

With only three classes of antifungals, antimicrobial-resistant fungal diseases (resistance to at least one antifungal) are difficult, sometimes impossible, to treat.

Some types of fungi can become resistant to all antifungal drugs. For example, Candida auris (C. auris) a fungus that emerged around the world in recent decades is often multidrug-resistant. Some cases have been resistant to all three classes of antifungals. C. auris mostly affects patients who are already very sick and can lead to severe illness or death

Global response to fungal diseases

The WHO fungal priority pathogens list (WHO FPPL) was developed to guide research, development, and public health action. Itis the first global effort to systematically prioritize fungal pathogens.

Causes of antimicrobial resistance

Resistance develops over time as fungi are exposed to antifungals used in human and animal medicine and in agriculture and industry.

Antifungal use in medicine

Overuse or misuse of antifungals in medicine can speed up the development of resistance. Examples include:

• Antifungal use to treat conditions not caused by fungi.
• Doses that are higher or lower than necessary to treat infections.
• Treatment durations that are longer or shorter than needed.
• Antifungal use to prevent infections when the risk is not high.

Fungicide use in plants and industry

Fungicides used to prevent and treat fungal diseases in agriculture and industrial fungicide use can also contribute to developing antifungal resistance. For example, fungicides, similar to medical antifungal drugs, are often used in the environment. When naturally-occurring Aspergillus is exposed to these fungicides, it can build resistance.

Types of antimicrobial-resistant fungi

Resistant fungi include Aspergillus, certain Candida species and strains, and certain dermatophytes (fungi causing ringworm). Candida auris, a newer species, is particularly resistant to antifungal drugs and can spread quickly in healthcare settings. Learn more:

• Aspergillus
• Candida
• Candida auris
• Ringworm

What CDC is doing

As part of CDC's Antimicrobial Resistance Solutions Initiative, CDC support efforts to slow antifungal resistance across domains.

Conducting national surveillance: Tracking antimicrobial resistance in Candida infections at 10 sites across the country through the Emerging Infections Program (EIP).

Expanding local lab capacity: Supporting the Antimicrobial Resistance Laboratory Network), a network of public health labs that preform antifungal susceptibility testing.

Optimizing state-of-the-art lab technology: Using genomic sequencing and developing new laboratory tests to identify specific mutations associated with antimicrobial resistance.

**Supporting surveillance globally: **Collaborating with the World Health Organization's (WHO's) Global Antimicrobial Resistance Surveillance System (GLASS) to increase global surveillance.

Using data for action: Analyzing antifungal prescribing patterns across healthcare facilities and promoting appropriate use of antifungal drugs

Learn more

CDC Actions to Prevent the Spread of Antifungal Resistance

Help prevent antimicrobial-resistant infections

Everyone can help slow down the development of antifungal resistance in big or small ways.

Healthcare facility leadership and infection control staff

• Include antifungal use in antimicrobial stewardship programs.
• Adhere to infection prevention and control guidelines.Follow protocols for hand hygiene and disinfection.

Healthcare providers and veterinarians

• Document dose, duration, and reason for every antifungal prescription.
• When possible, test for fungal diseases before prescribing treatment.
• Test for antifungal resistance if initial treatment is failing.
• Be aware of resistance patterns in the facility and community.

Antifungal Therapeutic Drug Monitoring (TDM)

Learn about the use of TDM for triazole antifungals.

Industry

• Stay updated on research on ways to reduce impact of fungicide use.
• Consider integrated pest management (IPM), recognized by WHO to:reduce need for pesticide use
• protect crop yield and food production

What you can do

• Clean your hands frequently.
• Learn if you or a loved one are at increased risk and what you can do.
• Take antifungals only when needed and exactly as prescribed.Take antifungals for as long as they prescribed.
• Talk to your doctor if you have side effects.
• Talk to your healthcare provider if a medication is not working.

Related Links

• Antimicrobial Resistance
• Antifungal Susceptibility Testing and Interpretation

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