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Ignore antifungal resistance at your peril, warn top scientists
Without immediate action, humanity will potentially face further escalation in resistance in fungal disease, a renowned group of scientists from the across the world has warned. The commentary - published in The Lancet -
was coordinated by scientists at The University of Manchester, the Westerdijk Institute and the University of Amsterdam. According to the scientists, most fungal pathogens identified by the World Health Organization – accounting for around 3.8 million deaths a year – are either already resistant or rapidly acquiring resistance to antifungal drugs. The authors argue that the currently narrow focus on bacteria will not fully combat antimicrobial resistance (AMR). Resistance has become the rule rather than the exception for the four currently available antifungal classes, making it difficult - if not impossible – to treat many invasive fungal infections. Fungicide resistant infections include
Aspergillus, Candida, Nakaseomyces glabratus, and Trichophyton indotineae, all of which can have devastating health impacts on older or immunocompromised people. Dr. Norman van Rhijn from The University of
Manchester coordinated the comment with Professor Ferry Hagen from the University of Amsterdam and the Westerdijk Institute in the Netherlands. Dr. van Rhijn said: “Most people agree that
resistant bacterial infections constitute a significant part of the AMR problem. However, many drug resistance problems over the past decades have also been the result of invasive fungal diseases largely under recognised by scientists, governments, clinicians and pharmaceutical companies. “The threat of fungal pathogens and antifungal resistance, even though it is a growing global issue,
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is being left out of the debate.” Unlike bacteria, the close similarities between fungal and human cells which, say the experts, means it is hard to find treatments that selectively inhibit fungi with minimal toxicity to patients. Professor Ferry Hagen added: “Despite the huge difficulties in developing them, several promising new agents including entirely new classes of molecules, have entered clinical trials in recent years.
“But even before they reach the market after
years of development, fungicides with similar modes of action are developed by the agrochemical industry resulting in cross-resistance. “That sets us back to square one again. It is true
many essential crops are affected by fungi, so antifungal protection is required for food security. But the question is, at what price?” The scientists recommended worldwide
agreement on restricting the use of certain classes of antifungal molecules for specific applications, along with collaboration on solutions and regulations that ensure food security and universal health for animals, plants, and humans. They also called for fungal infections to be made a priority alongside AMR.
Trusts that aim to improve productivity, reduce cancelled operations and enable people to be discharged from hospital more quickly by ring-fencing staff and resources for planned surgery. The research found:
l In their first year, the 31 Trusts in England with newly opened hubs undertook 21.9% more high volume low complexity elective surgery (such as hip replacements and cataract removals) than they would have done without a hub. This amounts to around 29,000 more procedures than expected at these Trusts during this time.
l In the year following the last COVID lockdown, the 23 Trusts which had established a hub pre-pandemic undertook 11.2% more elective surgery (of all kinds) than they would have done without a hub. This amounts to around 51,000 more procedures than expected at these Trusts between April 2021 and March 2022.
As well as higher treatment volumes, the research found evidence of shorter stays in hospital, suggesting that hubs also have the potential to improve efficiency in elective care delivery.
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www.clinicalservicesjournal.com I October 2024
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