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Reducing antimicrobial resistance begins with better fungal infection diagnosis
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Clinicians who fail to correctly diagnose fungal infections may overprescribe antimicrobials, increasing drug resistance worldwide, according to a study published in Emerging Infectious Diseases.
“If we’re trying to deliver globally on a comprehensive plan to prevent antimicrobial resistance, and we’re treating blindly for fungal infections that we don’t know are present with antibiotics, then we may inadvertently be creating greater antibiotic resistance,” David Perlin, PhD, executive director of the Public Health Research Institute Center at Rutgers New Jersey Medical School and member of the Global Action Fund for Fungal Infections (GAFFI), said in a press release.
WHO describes antibiotic resistance as one of the biggest threats to global health. It is related to 23,000 deaths each year and, in the United States, almost $25 billion in excess health care costs. Further, fungal infections, which are often underdiagnosed, account for 1.5 million deaths each year.
Although low-cost, rapid diagnostic tests exist for detecting important fungal infections, they are not being widely used, Perlin said. To administer drugs correctly, health care practitioners need better training in testing for fungal infections.
The report describes four commonly misdiagnosed fungal diseases that require attention to improve antimicrobial treatment:
- many patients with smear-negative tuberculosis may have Aspergillus spp. infection, which is diagnosed with a simple antibody test and is treated with less-expensive antifungal drugs vs. TB drugs;
- an inaccurate diagnosis of fungal sepsis can lead to invasive candidiasis and prescriptions of inappropriate broad-spectrum antibacterial drugs;
- fungal asthma, often misdiagnosed as chronic obstructive pulmonary disease, does not respond to antibacterial drugs, but can be treated with antifungal agents after diagnosis with skin and blood tests; and
- overtreatment/undertreatment of Pneumocystis pneumonia in patients with HIV.
“Fungal disease diagnostics are critical in the [antimicrobial resistance] fight and will improve survival from fungal disease across the world,” David Denning, FRCP, FRCPath, FMedSci, GAFFI president and professor of infectious diseases in global health at the University of Manchester, said in the release. “The close link between fungal diagnostics and antibacterial prescribing needs a great deal more attention.” – by Savannah Demko
Disclosures: Denning and Perlin are both members of the Global Action Fund for Fungal Infections.
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