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Antifungal Exposure and Resistance Development: Defining Minimal Selective Antifungal Concentrations and Testing
Emily M Stevenson1,2, William H Gaze1,2, Neil A R Gow3
1European Centre for Environment and Human Health, University of Exeter Medical School, Cornwall, United Kingdom.
Frontiers in Fungal Biology
|September 25, 2023
Summary
Antifungal resistance (AFR) is a growing health threat. This review highlights environmental factors driving AFR and proposes methods to assess risks, unlike current guidelines for antibacterial resistance.
Area of Science:
- Environmental science
- Microbiology
- Public health
Background:
- Antifungal resistance (AFR) poses a significant global health threat with high mortality and limited treatment options.
- Environmental settings, including agriculture and wastewater, are increasingly recognized as contributors to AFR evolution and spread.
- Current environmental risk assessment (ERA) guidelines lack methods to evaluate antifungal agents' potential to drive AFR.
Purpose of the Study:
- To summarize current knowledge on selection for antifungal resistance (AFR).
- To compare AFR selection with the more researched antibacterial resistance.
- To propose methods for assessing environmental risks associated with antifungal use.
Main Methods:
- Scoping review of existing literature on antifungal resistance selection.
- Comparison with established research on antibacterial resistance selection.
- Proposal of methods for determining antifungal selective concentrations, adapted from antibacterial research.
Main Results:
- AFR is an emerging threat, with environmental factors like agricultural fungicides and wastewater posing significant selection risks.
- Existing ERA guidelines do not assess the AFR development potential of antifungal agents.
- There is a lack of experimental tools to determine antifungal selective concentrations, limiting risk assessment.
Conclusions:
- Environmental exposure to antifungals can drive the selection of AFR.
- Regulatory guidelines need to incorporate the assessment of antifungal selective concentrations.
- Developing methods to determine antifungal selective concentrations is crucial for informing safe environmental thresholds and mitigating AFR spread.
