Review on Antifungal Resistance: Definition, Mechanisms, Diagnosis, Challenges and Solutions

Antifungal resistance (AFR) is rapidly emerging as a significant global health issue that poses a growing threat to public health, particularly for individuals with compromised immune systems. Fungal resistance has been considerably neglected, despite its increasing incidence and severity, while antimicrobial resistance (AMR) has been primarily focused on bacterial infections. AFR impedes the management of numerous infections caused by multidrug-resistant fungi, such as Candida auris, Aspergillus fumigatus, and Trichophyton indotineae, which leads to the escalation of healthcare expenses, increased mortality rates, and protracted hospital stays. This study discusses the mechanisms by which antifungal resistance is achieved, including the modification of the target, the utilization of efflux pumps, the formation of biofilms, and the degradation of enzymes. It also investigates the primary causes of resistance, including the misuse and abuse of antifungals, the use of fungicides in agriculture, climate change, and globalization. Despite the ongoing efforts of antifungal stewardship groups to address AFR, the sluggish development of novel antifungal medicines and the limited research available continue to pose significant challenges. Furthermore, the issue is further exacerbated by the absence of rapid diagnostic methods, which impedes the timely identification of resistant strains. We recommend a variety of global measures to combat AFR, including the implementation of enhanced surveillance systems, increased funding for research and development, the establishment of more robust stewardship programs, the promotion of public awareness, and the promotion of international cooperation through a "One Health" approach. Prompt and coordinated global measures are required to mitigate the effects of AFR, protect public health, and preserve the efficacy of antifungal therapies for future generations, in response to the growing threat.