High time to tackle drug-resistant fungal infections

* 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.

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.

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.