Emerging antifungal resistance: an updated review on current scenario, pathogens involved and tackling strategies.

Abstract

Antifungal resistance (AFR), an emerging and significant threat to humanity, receives far less attention than antibacterial resistance. AFR management is plagued by rising incidence in both immunocompromised and immunocompetent populations, zoonotic infections, limited fungal diagnostics, limited antifungal armamentarium with even fewer in pipeline, cross-resistance between environmental fungicides and clinically used antifungals, lack of strong antifungal stewardship programs, limited applications of novel strategies for human AFR, to name a few. In this review, we compile available information, current advances and our perspectives on major challenges in the origin and management of AFR. We conduct systematic review of all available publications on standard databases using search terms related to AFR from the past until January 2026. We consider all major publications on key questions in AFR. We focus on the following aspects of AFR: environmental drivers, AFR and "One Health" perspective, climate change and AFR, emerging fungal zoonoses, fungal diagnostic challenges and advances, key resistant fungal pathogens, antifungal stewardship programs, summarize the use of newer antifungals and their clinical trials, and provide an overview of novel strategies for tackling AFR, like the potential use of mycoviruses and vaccines. We also briefly present our perspective on the future of AFR progression and management. Fungi are tiny germs that can cause serious infections in humans. There are only a few medicines available to cure these infections. Sometimes, these medicines cannot kill the fungi. This is called antifungal resistance (AFR). When AFR happens, the fungus keeps growing in the body, making the person sicker and the infection does not heal. This resistance can develop when these medicines are used too much or unnecessarily, either in farming (to protect crops) or in people (when a different medicine was needed as the germ was different). It is important to detect fungal infections and resistance early so that the right treatment can be given. In the future, we need to develop new medicines, improve testing methods in the laboratory for detecting this germ early in patients, use antifungal medicines carefully, and create rules to prevent their unnecessary use, especially in farming. These steps will help keep the current medicines effective and prevent antifungal resistance, so that patients are cured of such infections.