After Bacteria, Experts Warn Of Rising Threat From Drug-Resistant Fungi

While antibiotic resistance in bacteria has already reached alarming levels globally, experts are cautioning that drug-resistant fungi, too, are emerging as the next major threat if not addressed in time.

Sounding an alarm bell, a group of 50 researchers from 16 international organizations has warned that antifungal resistance remains significantly under-recognized despite its potentially life-threatening consequences. In a recent publication in Nature Medicine, the experts pointed out that fungi are ubiquitous in the environment; and while they pose little risk to healthy individuals, they can cause severe and often fatal infections in vulnerable populations, including those undergoing cancer treatment, organ transplantation, or intensive care.

In their new study, led by Professor Paul Verweij, medical microbiologist at Radboud University Medical Center (Radboudumc), the experts have sought to address this gap through a structured five-step action plan aimed at improving preparedness and response.

The proposed strategy includes enhancing awareness, strengthening surveillance systems, improving infection prevention and control measures, optimizing the use of antifungal drugs, and increasing investments in research and healthcare infrastructure. The recommendations are expected to contribute to the revision of the World Health Organization’s Global Action Plan on AMR.

Clinically, fungal infections range from mild to severe. Common skin infections such as athlete’s foot and nail fungus are generally manageable. However, more aggressive and drug-resistant species are increasingly being reported. One such example is Trichophyton indotineae, which has been associated with persistent and difficult-to-treat skin infections, particularly in parts of South Asia.

More concerning are invasive fungal infections in hospital settings. Candida auris, an emerging pathogen, has been linked to serious bloodstream infections, especially in critically ill patients. Mortality rates remain high, with studies indicating that nearly one in three affected patients does not survive. Another pathogen of concern is Aspergillus fumigatus, a fungus commonly inhaled from the environment, which can cause severe lung infections in individuals with compromised immunity. “We inhale this fungus, and it can severely damage the lungs,” Prof. Verweij noted. “In recent years we have seen it more often in ICUs, for example in people with influenza.”

A key challenge in tackling antifungal resistance lies in its origin. Unlike many bacterial infections, resistance in fungi often develops outside healthcare settings. The widespread use of fungicides in agriculture—chemically similar to antifungal drugs used in medicine—has contributed significantly to this problem. Continuous exposure allows fungi to develop resistance, which can then spread through the air and enter human populations.

Experts stress that this interconnected pathway calls for a “One Health” approach, integrating human, animal, and environmental health strategies. Professor Michaela Lackner, microbiologist at the Medical University of Innsbruck, highlighted this concern, stating: “Dual use of antifungal targets in medicine and agriculture is accelerating resistance from fields to ICUs. Aligning agricultural authorizations with health risk assessments while investing in new antifungals and affordable diagnostics is a pragmatic One Health solution that protects both food security and patient care.”

The development of new antifungal drugs presents additional challenges. Fungi share a closer cellular structure with humans than bacteria do, making it difficult to design treatments that are both effective and safe. As a result, progress in antifungal drug development has been slow. “That’s why only five new classes of antifungal drugs have been developed in the past 75 years,” Prof. Verweij pointed out.

Given these limitations, experts emphasize that prevention and early detection must be prioritized. Strengthening diagnostic capacity, improving data collection, and ensuring rational use of existing antifungal drugs are critical components of an effective response.

Haileyesus Getahun, Director of the WHO program for global coordination on antimicrobial resistance, underscored the need for evidence-based action. “We need more data and evidence on fungal infections and antifungal resistance to inform and improve response to these priority fungal pathogens,” he said.

Warning of the consequences of inaction, Prof. Verweij added: “We are facing a silent surge of drug-resistant fungi—from Candida auris in ICUs to azole-resistant Aspergillus in the community—that is already costing lives. Antifungal resistance must be integrated into the 2026 Global Action Plan on AMR, with concrete milestones and funding, or we risk repeating the mistakes made with antibacterial resistance.”