Evolution of antifungal resistance in the environment

The emergence of drug-resistant fungal infections in agriculture and healthcare settings has caused severe implications for food security, public health and natural environments. They pose a substantial hazard for at-risk patient populations who often acquire serious and sometimes life-threatening infections. With the increasing use of fungicides in the environment, acquisition of resistance to fungicides and antifungal drugs pose a risk to health. In this Review we summarize the evolution, emergence and expansion of fungicide and antifungal drug resistance globally. We discuss different antifungals and fungicides, their modes of action and resistance mechanisms. Furthermore, we outline the current state of knowledge about the emergence and expansion of resistant fungi in hotspots and coldspots in the environment. Finally, we summarize alternative options and future directions in reducing antifungal resistance.