Open Access

The widespread use of azole compounds in various sectors has led to the emergence of azole-resistant Aspergillus fumigatus (ARAf), which poses a significant challenge for treating fungal infections, especially in immunocompromised patients. Certain environmental conditions and practices, particularly in agricultural settings and the use of azoles as biocides, have been identified as hotspots for the selection and dispersal of azole-resistant strains of Aspergillus spp. Factors contributing to the selection of resistance include the use of azoles in crop protection, wood preservation and, to a much lesser extent, veterinary medicine. For plant protection products (PPPs), a number of scenarios (green waste of indoor-grown vegetables, uses with the production of wet pomace used as fertiliser, maize or sugar beet silage, and field heaps including flower bulbs) are deemed high risk for hotspot development. Based on EU authorised use patterns, these scenarios are characterised by the hazard characteristics of the azole fungicides in terms of activity against the wild-type Aspergillus spp. compared to resistant strains, substrate characteristics and residue levels, and environmental conditions that promote the growth of the fungus. For biocidal azole applications, products (biocidal product [BP]) for temporary preservation of freshly cut wood have been identified to have the potential for hotspot formation because freshly cut wood allows the growth of Aspergillus spp., and azole concentrations in treated wood are above the predicted no effect concentration (PNEC) for resistance selection (PNECres) and below the minimum inhibitory concentration (MIC) of ARAf for most analysed products on the EU market. Following identification of environmental hotspots, the report recommends measures to prevent the selection of azole-resistant strains in the environment, including controlled storage of organic waste, proper waste management, and responsible use and disposal of azole-treated products. Azole use in veterinary medicinal products (VMPs) represents a very small percentage of total azole use and is unlikely to be a significant source of selection of resistance in the environment. As such, the focus for mitigating resistance should be on other uses of azoles. The report stresses the importance of ongoing surveillance to monitor the presence of ARAf in the environment and to inform risk assessments and management strategies. As industrial chemicals, the azole substances are mostly used as intermediates (precursors) to manufacture yet a different substance, are formulated into a mixture or are reported to be manufactured as active substances in PPP, BP or VMP (therefore already covered above). There are only a few industrial azole substances with widespread use, and as for the moment, there is no evidence from the literature that industrial azoles would be a source of a possible hotspot; thus, the industrial chemicals were not further investigated. There are several areas where further research is needed, including understanding the environmental conditions that support the growth of Aspergillus spp. in different agricultural matrices or on wood, assessing human exposure to resistant strains, regional waste practices and the impact of active substance combinations for azole resistance selection. There is also a need for more comprehensive data on the use and quantities of azole-containing products. Furthermore, industrial substances with widespread use and having antifungal effects, e.g. an antidandruff substance in cosmetics, could be further investigated. Measures were identified that could be implemented with respect to the use of azole fungicides in PPPs as well as in BPs and with respect to the storage, processing and disposal of crop (waste) materials containing azole residues to prevent or minimise the selection of environmental resistance or to minimise the spread of resistant Aspergillus spp. to patients. Any measures that slow down or prevent growth in the presence of azoles, sporulation and dispersal of Aspergillus spp. should be encouraged. A coordinated effort among various stakeholders, including farmers, manufacturers, industrial users, waste managers, regulatory bodies and scientists, is essential to effectively address the challenge of azole resistance in A. fumigatus.