Mitigation of Human-Pathogenic Fungi That Exhibit Resistance to Medical Agents: Can Clinical Antifungal Stewardship Help?

Claire M Hull; Nicola J Purdy; Suzy C Moody


Future Microbiol. 2014;9(3):307-325. 

In This Article

Is Clinical Antifungal Stewardship Enough?

Taken as a whole, the conceptual considerations and research evidence presented in this report suggest that the extent to which clinical antifungal stewardship can help mitigate the emergence of certain human-pathogenic fungi (namely environmental molds) that exhibit resistance to medical agents is limited. This is because factors outside the clinic appear to exert a much greater influence on the selection, evolution and epidemiology of human-pathogenic molds and their resistance traits (acquired and intrinsic) than those within. The impact of selection pressure from agricultural azoles on the development and spread of cross-resistance to medical triazoles in A. fumigatus provides a case in point. Taking A. fumigatus as a model (Figure 1) the possibility that cross-resistance to agricultural and medical azoles could already exist and develop in other environmentally ubiquitous, spore-forming molds warrants further attention. Given that our understanding of the epidemiology and biology (including lifecycles) of emergent human-pathogenic molds remains in its infancy and that those currently receiving greater attention represent only a snapshot of the diversity within the fungal kingdom (Table 2 & Table 3), it is fair to say that we simply do not know the full scale or epidemiology of antifungal resistance. We cannot afford to disregard this knowledge deficit now or in the future.