International Fungal Network for One-Health Resistance Surveillance: Antifungal Resistance (INFORM-AFR)



Antifungal resistance (AFR) is an increasing concern in fungal pathogens, including Aspergillus fumigatus, yeasts and uncommon moulds that may cause breakthrough infection. There are currently no international AFR surveillance programs, as public health surveillance commonly focusses on bacterial resistance.

Ongoing project

Acquired AFR may develop through in host resistance selection and through exposure of fungi to fungicides in our environment, underscoring the requirement for a One Health approach to AFR surveillance. In this proposal we aim to provide a snap shot of current national AFR surveillance initiatives through an online survey, including identifying the stakeholders involved.

We subsequently will organize a start-up workshop aimed to design surveillance programs that involves clinical and environmental sampling, the use of genomics tools and data management. We aim to involve all relevant stakeholders, including public health institutes, mycology excellence centres and reference laboratories, and environmental and veterinary research groups. The outcome of this workshop will be a surveillance framework that enables systematic resistance surveillance in multiple countries, thus allowing inter-country comparisons.

To increase efficacy, we aim to develop standardized surveillance for multiple fungal pathogens including A. fumigatus, yeasts and non-fumigatus moulds. Laboratory protocols (clinical and environmental), culture collections, case record forms, data management and exchange, privacy and ethical approval issues, and communication plans will be developed. Using this framework, we will apply for funding to secure support to perform surveillance and scientific research associated with the network.

Expected outcomes:

  • Snap shot of current resistance surveillance activities for yeasts, Aspergillus and other moulds and involved stakeholders in various countries and organisations
  • AFR surveillance network designs: Involving the various stakeholders will help to determine how we can build the surveillance network, which information is to be collected (including patient groups and fungal disease entities), how environmental surveillance can be accommodated, how surveillance data can be collected and shared.
  • Alignment between the AFR networks: the network aims using a uniform surveillance network to monitor various pathogens, including A. fumigatus, yeasts and non-fumigatus moulds. This would increase the efficiency of the combined effort although differences in the epidemiology and One-Health aspects need to be addressed.
  • An AFR surveillance funding proposal

Network partners

  • Paul Verweij, Radboud University Medical Centre, The Netherlands (Coordinator)

This network includes 29 partners from 14 countries:  Austria, Australia, Belgium, Denmark, France, Germany, Greece, India, Ireland, Norway, Spain, the United Kingdom, the Netherlands and the United States of America.