Bridging the gap between environment and patient; investigating the risk and transmission of antifungal resistance in Aspergillus fumigatus

曲霉病是一种由真菌引起的传染病，每年导致约100万人死亡。真菌孢子在空气、植物废弃物、花坛和花园土壤中随处可见。免疫系统功能不佳的人尤其有感染的风险。唑类抗真菌药物是治疗曲霉病的一线药物，同时在农业和园艺中发挥着保护作物的重要作用。不可避免地，这种在农业和临床环境中的双重使用导致了耐药性从田间传播到脆弱的患者。一些治疗中心现在发现，超过20%的曲霉病患者感染了这种真菌的抗药性菌株。几乎没有替代疗法，而那些确实存在的疗法效果要差得多，患者的耐受性也差得多。缺乏对新出现的抗真菌耐药性进行监测的环境监测，阻碍了减轻耐药性和提醒医疗保健部门注意潜在问题的战略的制定。为了解决这个问题，我们需要开发方法来监测这种重要病原体中出现的环境中的唑类耐药性和对即将到来的两用抗真菌药物的耐药性。最终，这项研究将为开发将临床上使用的抗真菌药物与农业中使用的抗真菌药物分开的方法提供基础。因此，在“一个健康”框架内，我们的知识也与负责任和可持续的作物保护的发展有关。

Aspergillosis is an infectious disease caused by a fungus, which kills around one million people each year. Fungal spores are found ubiquitous in the air and in plant waste material, flower beds and garden soil. People with poorly functioning immune systems are particularly at risk of infection. The azole-class of antifungals are frontline medicines for treatment of aspergillosis and at the same time simultaneously playing an essential role in agriculture and horticulture to protect crops. Inevitably, this dual-use of azoles in agricultural and clinical settings has resulted in resistance spreading from the field to vulnerable patients. Some treatment centres are now finding more than 20% of aspergillosis patients infected with a drug resistant strain of the fungus. There are few alternative treatments and those that do exist are far less effective and less well tolerated by patients. The absence of environmental surveillance to monitor emerging antifungal resistance has hindered the development of strategies to mitigate resistance and alert healthcare sectors about potential problems. To address this problem, we need to develop methods to monitor the emergence of environmental azole resistance and resistance to upcoming dual-use antifungals in this important pathogen. Ultimately this study will provide a foundation to support the development of approaches that disconnects antifungal use in the clinic from its use in agriculture. Within the One-health framework, our knowledge is therefore also relevant for the development of responsible and sustainable crop protection.