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、植物废料、花坛和花园土壤中无处不在。免疫系统功能低下的人尤其容易受到感染。唑类抗真菌药物是治疗曲霉病的一线药物，同时在农业和园艺保护作物方面发挥着重要作用。在农业和临床环境中，这种唑类药物的双重使用不可避免地导致耐药性从田间蔓延到脆弱的患者。一些治疗中心现在发现，20%以上的曲霉病患者感染了这种真菌的耐药菌株。几乎没有其他的治疗方法，而那些确实存在的治疗方法也远没有那么有效，患者的耐受性也较差。缺乏监测新出现的抗真菌药物耐药性的环境监测，阻碍了制定减轻耐药性和提醒卫生保健部门注意潜在问题的战略。为了解决这一问题，我们需要开发方法来监测这一重要病原体中出现的环境唑耐药性和即将出现的两用抗真菌药的耐药性。最终，这项研究将为支持将临床抗真菌应用与农业应用分离开来的方法的发展提供基础。因此，在同一个健康框架内，我们的知识也与发展负责任和可持续的作物保护有关。

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.