The rapid emergence of antifungal

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During recent decades, the emergence of pathogenic fungi has posed an increasing public health threat, particularly given the limited number of antifungal drugs available to treat invasive infections. In this Review, we discuss the global emergence and spread of three emerging antifungal-resistant fungi: Candida auris, driven by global health-care transmission and possibly facilitated by climate change; azole-resistant Aspergillus fumigatus, driven by the selection facilitated by azole fungicide use in agricultural and other settings; and Trichophyton indotineae, driven by the under-regulated use of over-the-counter high-potency corticosteroid-containing antifungal creams. The diversity of the fungi themselves and the drivers of their emergence make it clear that we cannot predict what might emerge next. Therefore, vigilance is critical to monitoring fungal emergence, as well as the rise in overall antifungal resistance.

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The authors acknowledge M. McCloskey for her assistance with data collection. A.C. is a fellow of the CIFAR programme Fungal Kingdom: Threats & Opportunities.

Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

Shawn R. Lockhart & Jeremy A. W. Gold

Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

Anuradha Chowdhary

National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Medical Mycology Unit, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

Anuradha Chowdhary

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The authors contributed equally to all aspects of the article.

Correspondence to Shawn R. Lockhart.

The authors declare no competing interests.

Nature Reviews Microbiology thanks Matthew Fisher, David Perlin and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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CDC Infection Prevention and Control for Candida auris : https://www.cdc.gov/fungal/candida-auris/c-auris-infection-control.html

Centers for Disease Control and Prevention antimicrobial-resistant Aspergillus : https://www.cdc.gov/fungal/diseases/aspergillosis/antifungal-resistant.html

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Lockhart, S.R., Chowdhary, A. & Gold, J.A.W. The rapid emergence of antifungal-resistant human-pathogenic fungi. Nat Rev Microbiol (2023). https://doi.org/10.1038/s41579-023-00960-9

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Accepted: 03 August 2023

Published: 30 August 2023

DOI: https://doi.org/10.1038/s41579-023-00960-9

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