title: Delivering on Antimicrobial Resistance Agenda Not Possible without Improving Fungal Diagnostic Capabilities.
abstract: Antimicrobial resistance, a major public health concern, largely arises from excess use of antibiotic and antifungal drugs. Lack of routine diagnostic testing for fungal diseases exacerbates the problem of antimicrobial drug empiricism, both antibiotic and antifungal. In support of this contention, we cite 4 common clinical situations that illustrate this problem: 1) inaccurate diagnosis of fungal sepsis in hospitals and intensive care units, resulting in inappropriate use of broad-spectrum antibacterial drugs in patients with invasive candidiasis; 2) failure to diagnose chronic pulmonary aspergillosis in patients with smear-negative pulmonary tuberculosis; 3) misdiagnosis of fungal asthma, resulting in unnecessary treatment with antibacterial drugs instead of antifungal drugs and missed diagnoses of life-threatening invasive aspergillosis in patients with chronic obstructive pulmonary disease; and 4) overtreatment and undertreatment of Pneumocystis pneumonia in HIV-positive patients. All communities should have access to nonculture fungal diagnostics, which can substantially benefit clinical outcome, antimicrobial stewardship, and control of antimicrobial resistance.
authors.forename: David W
authors.initials: DW
authors.lastname: Denning
authors.forename: David S
authors.initials: DS
authors.lastname: Perlin
authors.forename: Eavan G
authors.initials: EG
authors.lastname: Muldoon
authors.forename: Arnaldo Lopes
authors.initials: AL
authors.lastname: Colombo
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
authors.forename: Malcolm D
authors.initials: MD
authors.lastname: Richardson
authors.forename: Tania C
authors.initials: TC
authors.lastname: Sorrell
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000821:virology; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000209:etiology; D060085:Coinfection / Q000175:diagnosis; D015897:Comorbidity; D003951:Diagnostic Errors; D019468:Disease Management; D018450:Disease Progression; D004352:Drug Resistance, Microbial; D016469:Fungemia / Q000175:diagnosis / Q000382:microbiology; D005658:Fungi / Q000187:drug effects*; D006801:Humans; D008826:Microbial Sensitivity Tests; D009181:Mycoses / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000209:etiology; D015203:Reproducibility of Results; D014376:Tuberculosis / Q000175:diagnosis
chemical_list: D000935:Antifungal Agents
keywords: Aspergillus; Candida; Cryptococcus; HIV/AIDS and other retroviruses; Histoplasma; Pneumocystis; antibiotic drugs; antifungal drugs; antimicrobial drugs; antimicrobial resistance; bacteria; fungi; respiratory infections; tuberculosis and other mycobacteria