At a glance
Antimicrobial resistance (AR) happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. Some fungi are becoming antimicrobial-resistant and continue to grow and infect patients receiving antifungal medications. Patients with antimicrobial-resistant infections may be left with few treatment options. CDC supports initiatives worldwide to stop the emergence of AR. Healthcare providers, veterinarians, patients, and industries all have important roles to play to keep our medicines working.
The problem
Antimicrobials refer to medications used to treat infections caused by different types of microbes or germs. Antifungals are the type of antimicrobials that treat fungal infections. Currently, only a few types of antifungal drugs exist. Antifungal resistance further limits treatment options.
Some types of fungi can become resistant to all antifungal drugs. Antifungal-resistant fungal infections are increasing throughout the world and more resistant fungi are emerging. For example the emerging fungi Candida auris, is often multidrug-resistant and can cause deadly infections.
Global response to fungal diseases
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:
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
Help prevent antimicrobial-resistant infections
Everyone can help slow down the development of antifungal resistanc 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.
- 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.
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
- reduce need for pesticide use
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.
- Take antifungals for as long as they prescribed.
- Talk to your healthcare provider if a medication is not working.
- Ostrowsky B, Greenko J, Adams E, Quinn M, O'Brien B, Chaturvedi V , et al. Candida auris isolates resistant to three classes of antifungal medications — New York, 2019. MMWR Morb Mortal Wkly Rep 2020;69:6–9
- Lortholary O, Desnos-Ollivier M, Sitbon K, Fontanet A, Bretagne S, Dromer F, et al. Recent exposure to caspofungin or fluconazole influences the epidemiology of candidemia: a prospective multicenter study involving 2,441 patients. Antimicrob Agents Chemother 2011;55:532–8.
- Shah DN, Yau R, Lasco TM, Weston J, Salazar M, Palmer HR, et al. Impact of prior inappropriate fluconazole dosing on isolation of fluconazole-nonsusceptible Candida species in hospitalized patients with candidemia. Antimicrob Agents Chemother 2012;56:3239–43.
- Ben-Ami R, Olshtain-Pops K, Krieger M, Oren I, Bishara J, Dan, M, et al. Antibiotic exposure as a risk factor for fluconazole-resistant Candida bloodstream infection. Antimicrob Agents Chemother 2012;56:2518–23.
- WHO: Global Antimicrobial Resistance Surveillance System (GLASS)
- Patterson TF, Thompson GR, 3rd, Denning DW, Fishman JA, Hadley S, Herbrecht R, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016;63:e1–60.
- Reference 7Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016;62:e1–50.