Invasive fungal infections pose an important threat to public health and are an under-recognized component of antimicrobial resistance, an emerging crisis worldwide. Across a period of profound global environmental change and expanding at-risk populations, human-infecting pathogenic fungi are evolving resistance to all licensed systemic antifungal drugs. In this Review, we highlight the main mechanisms of antifungal resistance and explore the similarities and differences between bacterial and fungal resistance to antimicrobial control. We discuss the research and innovation topics that are needed for risk reduction strategies aimed at minimizing the emergence of resistance in pathogenic fungi. These topics include links between the environment and One Health, surveillance, diagnostics, routes of transmission, novel therapeutics and methods to mitigate hotspots for fungal adaptation. We emphasize the global efforts required to steward our existing antifungal armamentarium, and to direct the research and development of future therapies and interventions.

侵袭性真菌感染对公众健康构成重要威胁，并且是抗菌素耐药性这一全球新兴危机的一个未被充分认识的组成部分。在全球环境发生深刻变化和高危人群不断扩大的时期，感染人类的​​病原真菌正在对所有获得许可的全身性抗真菌药物产生耐药性。在这篇综述中，我们重点介绍了抗真菌耐药性的主要机制，并探讨了细菌和真菌对抗菌药物耐药性的异同。我们讨论了旨在最大限度地减少病原真菌耐药性出现的风险降低策略所需的研究和创新主题。这些主题包括环境与 One Health 之间的联系、监测、诊断、传播途径、减轻真菌适应热点的新疗法和方法。我们强调需要全球努力来管理我们现有的抗真菌设备，并指导未来疗法和干预措施的研发。