Antifungal resistance exists

One of the main barriers to successful antifungal stewardship is awareness. Antibiotic stewardship (aimed mainly at common bacterial infections) is now well established in many hospitals. This has led to an increased recognition of the issue. Challenges relating to antifungal treatments are less widely appreciated.

The message for Week 3 is simple: Antifungal resistance exists and is a growing problem. Therefore, the focus of antifungal stewardship has to move on from the financial burden of antifungal prescribing to protecting the activity of the antifungal drugs. This means that antifungal susceptibility testing has to be available for all clinically relevant isolates including moulds. Knowledge of local epidemiology with continuous surveillance is important for developing local guidelines for antifungal treatment.

Below is a timeline of antifungal resistance development:

Antifungal resistance poses many of the same threats as antibiotic resistance. The emergence of treatment-resistant invasive fungal infections is of particular concern. As the number of available antifungal drug classes is small and cross-resistance within each class is common, treatment options for critically ill patients soon become extremely limited. In line with this, infections caused by multi-drug resistant fungi have been associated with higher mortality and treatment failure rates.

This creates a concerning landscape for the future. Antifungal stewardship needs to garner attention now so this trend can be abated.