Antifungal Resistance Surveillance: Insights From National Mycology Reference Centers and Expert Mycology Laboratories

Fungal pathogens and the infections they cause are notoriously understudied and underrepresented in public health surveillance programs. Recent initiatives, such as that of the Joint Programming Initiative on Anti-Microbial Resistance (JPIAMR), recognize these gaps and have supported the development of a fungal surveillance resistance network. The International Fungal Network for One-Health Resistance Surveillance: Antifungal Resistance (INFORM-AFR) network sought to enhance understanding of existing surveillance programs, with the ultimate goal of developing standardized fungal surveillance strategies that enable international comparisons. A survey was conducted involving mycology reference centers or public health institutes (n = 15) from 12 countries, each responsible for nationwide or regional surveillance programs on fungal infections or pathogens. The ongoing programs were heterogenous, not only in terms of the epidemiological focus of surveillance (pathogen vs disease based), but also in relation to the mycological procedures used (identification and antifungal susceptibility testing methods). Funding dedicated to surveillance was variable and often lacked long-term stability, resulting in suboptimal surveillance data in many centers and limiting the generation of accurate and consistent knowledge. With the expanding number of fungal disease cases and increasing reports of antifungal resistance, we strongly advocate for improved integration of fungal infections into nationwide health surveillance programs as well as international standardization.