Bridging the gap between environment and patient; investigating the risk and transmission of antifungal resistance in Aspergillus fumigatus
( GAP-AFR )

Antimicrobial resistance is a global problem, and the rapid emergence of drug resistance of human fungal infections is of high concern. Unfortunately, insufficient research efforts and opportunities in the past have resulted in a lack of surveillance systems to track antifungal resistant Aspergillus fumigatus, as well as an incomplete understanding of how antifungal resistance evolves or can be managed. A. fumigatus is a common, ubiquitous saprophytic fungus that can cause fatal invasive infections in immune-compromised patients. Antifungal azole compounds have been effective in treating Aspergillus diseases in humans and animals but are also used for crop protection against plant pathogenic fungi. Exposure to azole fungicides in the environment is a major driving force for resistance selection and multi-azole resistant A. fumigatus genotypes are globally detected in clinical isolates. This severely threatens human fungal disease management yet appropriate risk assessments for dual-use antifungal compounds are surprisingly lacking. To address this need we will develop tools to detect the emergence of dual-use antifungal resistance and provide appropriate risk assessments strategies. In addition, we aim to bridge the gap between environment and patient by using air sampling surveillance to investigate the exposure risk of antifungal resistant A. fumigatus in a wide range of geographical areas (including EU and Africa). Analysing antifungal resistance patterns will strengthen future surveillance methods and investigations by advancing comprehension of transmission routes.