Poor fungal infection diagnosis may up antibiotic resistance

Poor diagnosis worldwide of fungal disease causes doctors to over-prescribe antibiotics, increasing harmful resistance to antimicrobial drugs, a new study has warned.
According to World Health Organisation (WHO), antibiotic resistance is one of the biggest threats to global health. It is linked to 23,000 deaths per year, researchers said.
Paying closer attention to underlying fungal infections is necessary to reduce drug resistance, they said.
"If we are trying to deliver globally on a comprehensive plan to prevent antimicrobial resistance, and we are treating blindly for fungal infections that we do not know are present with antibiotics, then we may inadvertently be creating greater antibiotic resistance," said lead author David Perlin, from Rutgers New Jersey Medical School in the US.

Inexpensive, rapid diagnostic tests are available for important fungal infections but are not being widely used, said Perlin.
Better training is needed to encourage health care practitioners to test for fungal infections so the correct drugs are administered.

The report cites four common clinical situations in which a lack of routine diagnostic testing for fungal diseases often worsens the problem.
It said many people diagnosed with tuberculosis of the lungs do not have TB - known as smear negative cases - but are treated ineffectively with costly TB drugs.
A simple antibody test can pick up the fungus Aspergillus, which can be treated by antifungal drugs rather than unnecessary anti-TB antibiotics. In 2013, more than 2.7 million smear-negative TB cases were reported to the WHO.

Inaccurate diagnosis of fungal sepsis in hospitals and intensive care units results in inappropriate use of broad-spectrum antibacterial drugs in patients with invasive candidiasis, fungal infections caused by yeasts.
Fungal asthma is often misdiagnosed as chronic obstructive pulmonary disease (COPD) and treated with antibacterial drugs and steroids.
Of more than 200 million asthma sufferers, an estimated 6 million to 15 million have fungal asthma, which can be diagnosed with skin testing or blood tests and responds to antifungal agents, not antibiotics, the report notes.
"Fungal disease diagnostics are critical in the AMR fight and will improve survival from fungal disease across the world," said David Denning from the University of Manchester in the UK.

The study was published in the journal Emerging Infectious Diseases.