The comment piece -  published in The - was coordinated by scientists at The University of Manchester, the Westerdijk Institute and the University of Amsterdam.

According to the scientists most fungal pathogens identified by the World Health Organisation - accounting for around 3.8 million deaths a year - are either already resistant or rapidly acquiring resistance to antifungal drugs.

The authors argue that the currently narrow focus on bacteria will not fully combat antimicrobial resistance (AMR).

September’s United Nations meeting on antimicrobial resistance (AMR) must, they demand, include resistance developed in many fungal pathogens.

Resistance is nowadays the rule rather than the exception for the four currently available antifungal classes, making it difficult - if not impossible – to treat many invasive fungal infections.

Fungicide resistant infections include Aspergillus, Candida, Nakaseomyces glabratus, and Trichophyton indotineae, all of which can have devastating health impacts on older or immunocompromised people.

Dr Norman van Rhijn from The University of Manchester coordinated the comment piece with Professor Ferry Hagen from the Westerdijk Institute in the Netherlands.

Dr van Rhijn said: “Most people agree that resistant bacterial infections constitute a significant part of the AMR problem.

“However many drug resistance problems over the past decades have also been the result of invasive fungal diseases largely underrecognized by scientists, governments, clinicians and pharmaceutical companies.

“The threat of fungal pathogens and antifungal resistance, even though it is a growing global issue, is being left out of the debate.”

Unlike bacteria, the close similarities between fungal and human cells which, say the experts, means it is hard to find treatments that selectively inhibit fungi with minimal toxicity to patients.

Professor Ferry Hagen from the University of Amsterdam added: “Despite the huge difficulties in developing them, several promising new agents including entirely new classes of molecules, have entered clinical trials in recent years.

“But even before they reach the market after years of development, fungicides with similar modes of action are developed by the agrochemical industry resulting in cross-resistance.

“That sets us back to square one again. It is true many essential crops are affected by fungi, so antifungal protection is required for food security. But the question is, at what price?”

The scientists recommend:

• Worldwide agreement on restricting the use of certain classes of antifungal molecules for specific applications.
• Collaboration on solutions and regulations that ensure food security and universal health for animals, plants, and humans.
• Adding priority to AMR to fungal infections at the UN’s meeting in September.

Comment pieces are written by experts in the field, and represent their own views, rather than necessarily the views of The Lancet or any Lancet specialty journal. Unlike Articles containing original research, not all Comments are externally peer reviewed. 

The paper Beyond Bacteria: The Growing Threat of Antimicrobial Resistance in Fungi is available

A study in the United States has shown that attitudes among community nurses are important for their compliance with infection control practices.

The study, by researchers at The University of Manchester, Columbia University, the Visiting Nurse Service of New York and Appalachian State University in the US, is published in the American .

The survey of 359 community nurses analysed knowledge, attitudes and reported compliance with practice guidelines looking at the relationship between attitudes to infection and actual compliance to infection control norms.

The study is led by Dr Jingjing Shang from Columbia University School of Nursing, with Dr David Russell from the Visiting Nurse Service of New York and Department of Sociology, Appalachian State University.

The survey revealed that attitudes and organisational culture, rather than knowledge base was much more likely to inculcate greater compliance with infection control.

Older nurses were more likely to report self-compliance as were Non-Hispanic black nurses - a cultural designation specific to the United States- who were 24% more likely than other groups to self-report compliance

The percentage of community nurses in the survey who reported compliance with infection control practices exceeded 90% for most of the measured behaviours.

However, 81.9% said they wear a disposable face mask whenever there is a possibility of a splash or splatter, and 79% said they wear a gown if soiling with blood or bodily fluids is likely.

And 78.8% - 69.6% said they wear goggles or an eye shield when of exposed to bloody discharge or fluid.

Slightly more than two-thirds of respondents said that the influenza vaccine is safe (68.5%), and 60.4% of them felt it was easy for them to stay at home when they are sick.

And almost all the respondents failed to identify that hand hygiene should be performed after touching the nursing bag, which may transport infectious pathogens between patients.

, from The University of Manchester is on the research team.

She said: “Infections such as urinary tract, respiratory, wound, and sepsis are one of the major reasons why patients are admitted to hospital. But we know very little about controlling it in the community

“In fact, the community is a place where control is more difficult as patients may live in a variety of circumstances, with varying degrees of hygiene and knowledge.”

“We find most of the nurses said they were compliant with infection control protocols, but some said they were not.”

She added: “We’re not entirely sure why older nurses are more likely to comply with infection control protocols, but it’s probably a combination of factors.

“One possibility could be that older nurses have probably spent more time in the same organisation and whose infection control practices have become second nature to them

“But our key message is that infection control is not necessarily about knowledge- as most of the nurses surveyed had been working for some time.

“So more training, for example, might not necessarily change behaviour; we felt from this research that inculcating good practice into the organisational culture is likely to be more effective.”

The research is funded by the US Agency for Healthcare Research and Quality

The paper is published in the American Journal of Infection Control.