Prevention of Fungal Infections

The emerging phenomenon of antifungal resistance is a growing public health problem. Measures need to be taken to ensure the prevention of fungal infections and to reduce antifungal resistance.

Antifungal medications are critical for curing dangerous and potentially fatal fungal infections. Similar to the growing problem of antibiotic resistance, fungi that no longer respond to certain antifungal medications pose a major health challenge. Invasive infections caused by the fungus Candida require particular focus and attention.

Antifungal Resistance is Severely Underestimated

Unfortunately, the problem of antifungal resistance is severely underestimated, primarily because there is a lack of knowledge about the effects of such resistance and the burden that is associated with drug-resistant fungal infections. There is a need to improve an understanding of the emerging problem of antifungal resistance among the medical and public health communities and to implement methods that can be used to help prevent and control it.

Invasive fungal infections are responsible for significant morbidity and mortality. A large majority of healthcare associated bloodstream infections in the US are caused by Candida and each case of candidemia results in an additional 3 to 13 days of hospitalization and approximately $6000 to $29000 in healthcare costs.

The most worrisome aspect of this scenario is that many types of Candida, in particular C. auris, have now become resistant to fluconazole and echinocandin (first and second line of antifungal medications). Nearly 7 percent of Candida bloodstream isolates have been found to be resistant to fluconazole. While resistance to fluconazole has remained fairly constant over the years, resistance against echinocandin is consistently increasing. Approximately 1 percent of all Candida isolates have demonstrated resistance to echinocandin. This is a cause for concern because echinocandin are typically used to treat infections caused by C. giabrata, the species that is already resistant to fluconazole.

Very few treatment options thus remain for those infected with Candida infections that are resistant to both fluconazole and echinocandin. Also, these options are either too expensive or have adverse side-effects. Studies show that patients infected with drug-resistant candidemia have poorer outcomes as compared to patients with candidemia that is susceptible to antifungal medications.

Another emerging issue is the growing resistance to Aspergillus. Global prevalence of azole resistance to aspergillus is believed to around 3 to 6 percent. Aspergillus infections also have high mortality. Patients with previous exposure to antifungal medications are already vulnerable to aspergillus infections. Studies suggest that aspergillus resistance may be caused by the use of agricultural azoles. However, more research needs to be conducted in this area.

Antifungal Resistance is an Important Health Issue

Overall, it is evident that antifungal resistance is an important health issue that to date, has been ignored and overlooked. The problem will get worse if measures are not taken to prevent resistance and curtail the spread of antifungal infections. Some measures could include the implementation of antibiotic stewardship programs and adhering to guidelines related to hand hygiene, environmental infection control efforts and prevention of catheter-associated infections.

Healthcare professionals need to ensure that they are prescribing antifungal medications appropriately and that each antifungal prescription’s dose, duration and indication is appropriately recorded. They also need to keep up with antifungal resistance patterns and should play an active role in promoting better antifungal prescribing practices.