International Fungal Network for One-Health Resistance Surveillance: Antifungal Resistance


Research Network: 2023-04-01 - 2024-03-31
Total sum awarded: €50 000

Antifungal resistance (AFR) is an increasing concern in fungal pathogens, including Aspergillusfumigatus, yeastsand uncommon moulds that may cause breakthrough infection. There are currently no international AFRsurveillance programs,aspublic health surveillance commonly focus on bacterial resistance. Acquired AFRmay 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 nationalAFRsurveillance initiatives through anonline survey, including identifyingthe stakeholders involved (deliverable 1). We subsequently willorganize a start-up workshop aimed to design surveillance programsthat 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 centresand 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 (deliverable 2). To increase efficacy we aim to develop standardized surveillance for multiple fungal pathogens including A. fumigatus, yeastsand non-fumigatusmoulds (deliverable 3). 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 (deliverable 4).

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  • Paul Verweij, Radboud University Medical Centre, Netherlands (Coordinator)
  • Lewis White, PHW Mycology Reference Laboratory, United Kingdom (Observer)
  • Matthew Fisher, Imperial College London, United Kingdom (Observer)
  • Elizabeth Johnson, UK Health Security Agency, United Kingdom (Observer)
  • Riina Richardson, Manchester University Foundation Trust, Wythenshawe Hospital, United Kingdom (Observer)
  • Alexandre Alanio, Institut Pasteur, France (Observer)
  • Fanny Lanternier, Université Paris Cité, France (Observer)
  • Jean-Pierre Gangneux, Université de Rennes, France (Observer)
  • Laurence Millon, University Hospital of Besançon, France (Observer)
  • François Danion, University Hospital of Strasbourg, France (Observer)
  • Katrien Lagrou, University Hospitals Leuven, Belgium (Observer)
  • Julia (Jianhua) Zhang, National Institute for Public Health and the Environment (RIVM), Netherlands (Observer)
  • Eveline Snelders, Wageningen University & Research, Netherlands (Observer)
  • Thomas Rogers, Trinity College Dublin, Ireland (Observer)
  • Alida Fe Talento, Children’s Health Ireland, Ireland (Observer)
  • Ida Skaar, The Norwegian Veterinary Institute, Norway (Observer)
  • Cecile Torp-Andersen, Oslo University Hospital, Norway (Observer)
  • Ana Alastruey-Izquierdo, Instituto de Salud Carlos III, Spain (Observer)
  • Francisco Javier Sanchez Iñigo, Instituto de Salud Carlos III, Spain (Observer)
  • Cornelia Lass-Flörl, Institut of Hygiene and Medical Microbiology, Austria (Observer)
  • Martin Hoenigl, Medical University of Graz, Austria (Observer)
  • Joseph Meletiadis, National and Kapodistrian University of Athens, Greece (Observer)
  • Anuradha Chowdhary, Vallabhbhai Patel Chest Institute, University of Delhi, India (Observer)
  • Shawn Lockhart, Centers for Disease Control and Prevention, USA (Observer)
  • Orla Morressey, Alfred Health, Australia (Observer)
  • Sarah Kidd, SA Pathology, Australia (Observer)
  • Elvis Temfack, Africa Centers for Disease Control and Prevention, Ethiopia (Observer)
  • Oliver Kurzai, Julius-Maximilians-University of Wuerzburg, Germany (Observer)
  • Oliver Cornely, University of Cologne, Germany (Observer)
  • Maiken Cavling Arendrup, Statens Serum Institute, Denmark (Observer)

Fungi may cause severe systemic infections in humans. Pathogens include Aspergillus fumigatus, various yeasts (Candida and Cryptococcus) and non-fumigatus molds.For the treatment of these invasive fungal diseases doctors rely on antifungal drugs of which the number of options are limited. Over the past decade resistance to antifungal drugs has emerged, especially against the azole class. In A. fumigatus the dual use of azoles for treatment of human infection and for crop protection, has caused cross-resistance. The problem is that when patients inhale resistant spores and become ill, azole medicines are no longer effective leading to treatment failure. In addition, new drug resistance yeasts have emerged, including Candida auris, which is spreading worldwide causing severe infections in patients. Given the close relationship between the environment, where fungi have their habitat and human infection, the problem of emerging antifungal resistance (AFR) requires a One Health approach involving researchers from medical, agricultural, veterinary and public health backgrounds. Currently little is known about the epidemiology of AFR due to lack of surveillance networks. Our proposal is aimed to set up networks that can monitor the frequency of AFR in various fungi. We aim to organise a workshop to determine how best we can get the AFR surveillance organized. A standardized method will provide important information regarding the frequency of resistance in many countries and will allow for inter-country comparisons.