I think it’s just a matter of priorities and funding, which fungal infections as a whole don’t get enough of in general.
Save this criticism for the people who aren't nuanced, they left avenues. Mitigation, not eradication.
Before you take this personally, I'm talking about the quotes. Not history.
edit: downvoters and I would also disagree RE: Sisyphus. The punishment is worth it, bro. /s
* There is limited evidence that farming use of antibiotics is what drives resistance in clinical cases. That is - we use enormous amounts of antibiotics in farming, but the resistance it creates doesn't really seem to move into the hospitals.
* There is no reason to believe we've hit a wall and can't invent more antibiotics in the future. Historically we haven't focused much on antibiotics because we already have a bunch, and because there is less money in developing those drugs compared to e.g. lifestyle drugs or chemotherapy.
* We can still adopt better policies in the future to fight against resistance. For example, some countries crazily overprescribe antibiotics, or prescribe broad spectrum ones. We can also still amp up hygiene in hospitals - literally paying more people to scrub and boil and sterilize stuff will work.
* There are still some antimicrobial treatment techniques we haven't put a lot of resources in. Like, bacteriophage treatments, or cycling antibiotics.
That just kicks the can down the road though. Assuming that the use of any antibiotic will eventually lead to a predominance of resistance, we would have to continue to invent new, effective antibiotics indefinitely.
> For example, some countries crazily overprescribe antibiotics, or prescribe broad spectrum ones
I don't think its as simple as over prescription being the problem. My grandmother is pretty I'll these days, she suffers from dementia, is sick frequently, and generally just very warn down. She had a respiratory infection this week and while at the doctor they also found that she has a UTI. The prescribed her two different, non-broad spectrum antibiotics.
I don't think anyone would consider that over prescribing, and she likely would have a very bad outcome without it, but it also seems totally reasonable that her scenario could still lead to antibiotic resistance. Her immune system just doesn't work well anymore, the antibiotics will take out most of the infection and her symptoms will likely go away but I wouldn't expect her body to do the job of cleaning up the rest of the infection, leaving the more resistant strains around in her system.
Theoretically once you have enough antibiotics that we can retire drugs with heavy resistance and keep cycling them, you won’t need to keep creating new antibiotics.
There is no alternative to inventing new weapons continuously. We are simply used to winning without much effort since Fleming found penicillin, a naturally occurring fungal compound. Previous successes have limited the economics of continuing to develop new solutions, which is contributes to the uptick in resistance.
This doesn't mean we shouldn't be judicious in the tradeoffs that we choose and try to avoid a purely chemical solution to the arms race. For example, as robotics get better, we should move away from mono-cropping toward combinations of plants that naturally ward off pests. There are better ways to stay ahead than blunt tools.
This is a classic example of asymptotic behaviour analysis.
>That is - we use enormous amounts of antibiotics in farming
You're entirely correct, the data fits an almost exponential curve, the only limiting factor so far has been soil health and costs. the amount of biocides we have to use to keep our productivity will be impossible to match and therefore, even with 0 transference of resistance to human antibiotics, you're gonna see more transference to humans because of farming-biocide resistance. ofcourse, most of this will result in lower crop yield instead of actually selling bad product, this can be slowed down with essentially the same policies and techniques as hospitals employ. But the core problem is the exact same, the extremely quick and deadly takeover of a single strain resistent against our current quo pro due to overuse of a single line of defence.
Effects of climate change on fungal infections https://journals.plos.org/plospathogens/article?id=10.1371%2...
Zoonotic Risk from other mammals to humans will increase similarly. Pigs, cows or poultry might become spread the adaptions and then spread them to humans.
Your link only mentions Candida auris. I do not find it compelling to blame this on recent global warming for two reasons: 1) Regional and seasonal temperature variation is much greater than global variation and therefore the first place to look for temperature-specific adaptation, 2) The presence of an adaptation to the human body temperature in a human pathogen is not exactly remarkable or new.
The thing about Candida auris is not that it is heat-resistant, but that it is drug resistant. IMO, it's worth looking at the evidence that the appearance of Candida auris is related to the use of agricultural antifungals in East Asian agricultural production.
Can you elaborate on share documents on this? I’m wondering why east asia is different in anti fungal usage.
"I’m wondering why east asia is different in anti fungal usage."
It is a logical error to assume that it has to be substantially different. East Asia is simply the region that Candida auris originates from (ie., evolved in). It was first noticed in Tokyo and South Korea, and eventually India a few years later.
EDIT:
Actually, looks like there's some evidence that multiple evolutionarily-separate unrelated strains attained drug resistance one after another. Presumably the same antifungal agricultural product would have been in widespread use if this is the cause. If you look at the PLOS article linked in the NYT article in my link, they give an example of this for Aspergillus fumigatus strains.
[1] https://journals.plos.org/plospathogens/article?id=10.1371/j...
• C. auris does have unusual thermotolerance -- it grows up to 42C which is unusual compared to other Candida species.
• C. auris does not appear to be a typical commensal of mammals, or other high body temp animals, and hence it's thermal tolerance is likely not due to selection for this aspect of the host niche
Some more info on C. auris and hypotheses about origins here:
• Sharma C, Kadosh D. Perspective on the origin, resistance, and spread of the emerging human fungal pathogen Candida auris. PLoS Pathog. 2023 Mar 23;19(3):e1011190. doi: 10.1371/journal.ppat.1011190. PMID: 36952448; PMCID: PMC10035752.
But I agree
https://www.pnas.org/doi/10.1073/pnas.1711842115
I saw a good 3D visualization of this data using a customized version of Minecraft:
https://www.weforum.org/stories/2021/08/total-biomass-weight...
What about letting a more innofensive variant spread? You know, not cleaning stuff just because it is slightly moldy (doesn't mean eating it!).
It would be hilarious if cleaning is actually what selects the strongest bacteria and funghi to thrive. I mean tragic, not hilarious.
But I'm no biologist. I have only mediocre high school understanding of such things.
Is it just that they select resistant fungi and we eat that?
Or is it that we eat leftover azoles and thus build up immunity?
pmags•3d ago
Around 3.8 million people die each year of infections caused by C. auris and other fungi. Annual deaths caused by fungal infections have nearly doubled in the past decade.
Pathogenic fungi pose unique challenges, and overcoming them will require innovative approaches to both science and policy. Yet, despite the growing global threat posed by drug-resistant fungi, such infections rarely loom large in discussions of antimicrobial resistance. Two World Health Organization (WHO) reports published this month (see go.nature.com/3rniybw) — the organization’s first analyses of tests and treatments for fungal infections — highlight the result of that neglect.
kinow•10h ago
I hope WHO or some group of researchers somewhere will start studying how to tackle these fungi infections. Given the current situation of global conflicts, political situation, and economy around the world, if these infections become more widespread and resistent if could be devastating.
Loughla•3h ago
Edit: what did I say that was incorrect?