The Food Standards Agency (FSA) monitors risks from global food and feed imports and will take action to control these where there is a risk to public health. FSA monitoring has not identified drug-resistant fungi as an issue of concern for food currently entering Great Britain.

The FSA is not aware of any specific risks to consumers associated with drug-resistant fungi in food. It is not conducting any specific research or surveillance in this area. However, the FSA is cognisant of the growing risk to human health associated with some fungi present in the environment, which are developing drug resistance. Research is being funded to understand this risk better, for example through the Fungal One Health and Antimicrobial Resistance (AMR) Network funded by UK Research and Innovation. The FSA also continues to play its part in the fight against AMR through active participation in the UK’s AMR National Action Plan and its programme of research and surveillance focused on foodborne bacterial pathogens.

In support of AMR Action Plan commitments, the Environment Agency actively carries out research into environmental AMR, including antifungal resistance.

Currently the Health and Safety Executive (HSE) considers the potential for resistance development in the target pest organism during the plant protection product approvals process. Where resistance is known or anticipated, HSE places specific limitations on the use of the product to help mitigate the likelihood and speed of resistance development.

Defra is taking action to address the risks of resistance building by empowering farmers to make informed decisions as they manage pests, weeds and diseases. The UK Pesticides National Action Plan (NAP) sets out the actions we will take to support effective and sustainable pest management. A key goal in the NAP is increasing uptake of integrated pest management – a holistic approach that reduces the likelihood of resistance building by minimising and optimising pesticide use.

Candidozyma, formerly Candida, auris is an emerging multi-drug resistant fungal pathogen. Candidozyma auris is becoming more widespread globally, can result in serious infections in vulnerable individuals, and has been associated with outbreaks in healthcare settings that have resulted in substantial service disruption. The addition of candidozyma auris to the Health Protection (Notification) Regulations as a notifiable organism under Schedule 2 enables the UK Health Security Agency to more closely monitor this pathogen and inform public health action to limit its spread within the United Kingdom.

The Health Protection (Notification) (Amendment) Regulations 2025 Impact Assessment, a copy of which is attached, highlights that testing for candidozyma auris would be conducted within National Health Service and private laboratories. The burden on laboratories for additional testing is likely to be low, as testing is straightforward.

The UK Health Security Agency (UKHSA) routinely monitors the candidozyma auris situation in England and shares information with hospitals and health system partners so they can put in place timely measures to protect patients.

There is no published UKHSA data on fatality associated with invasive candidozyma auris infection, however the UKHSA is closely monitoring situation in England with improved surveillance, including the attributable and all-cause mortality for candidozyma auris.

Candidozyma auris cases have increased in the United Kingdom in recent years. Our most recent epidemiological commentary states that between January 2013 and April 2025 inclusive, a total of 800 candidozyma auris cases, both infections and colonisations, where people are carrying the organism on their skin without any symptom or illness, were reported in England. Reassuringly, the vast majority of these are colonisations, with 87% being colonised, 12% being invasive, and 1% of an unknown specimen type. Colonisation without invasive infection has a negligible risk of negative health outcomes. The UKHSA is currently validating a process for reporting mortality figures as part of future routine data releases. Further information and guidance is available on the candidozyma auris collection page, at the following link:

https://www.gov.uk/government/collections/candidozyma-auris

NHS England’s national pharmacy and prescribing clinical lead is supported by seven regional antimicrobial stewardship leads, which collaborate with stakeholders in infection prevention and control and patient safety and with the Care Quality Commission to mitigate the threat of antimicrobial resistance, including from dual use of antifungals.

The Environment Agency is investigating antifungal resistance in the environment to determine whether particular levels of antifungals in surface waters from releases by agriculture or water treatment may lead to resistance. It is engaging with external bodies including leading United Kingdom universities and the research councils. The UK Health Security Agency is releasing regular reports on fungal infection surveillance and antifungal prescribing data for a selection of fungal pathogens.

The Medical Research Council is funding the Centre for Medical Mycology at the University of Exeter to undertake research into the use of antifungals in medicine. The Centre will host a National Institute for Health and Care Research (NIHR) Biomedical Research Centre on clinical mycology and therapeutics to prevent and manage potentially deadly fungal infections. While the NIHR has not supported specific research on dual use of antifungals and it is not usual practice to ring-fence funds for particular topics or conditions, the NIHR has invested more than £6 million in research into fungal infection in the last five years.

The UK Health Security Agency is collaborating with medicinal chemists at the School of Cancer and Pharmaceutical Sciences at Kings College London, to develop new antimicrobials with novel modes of action for the World Health Organization’s priority pathogens. A series of compounds which evade efflux-mediated resistance are in development. Early-stage pre-clinical development has gained support from the National Institute of Allergy and Infectious Diseases through its Preclinical Services team, for studies on pharmacodynamics and pharmacokinetics and efficacy.

While it is not usual practice to ring-fence funds for particular topics or conditions, the National Institute for Health and Care Research has invested more than £6 million in research into fungal infection.

The National Institute for Health and Care Research (NIHR) is supporting the ‘UK 5-year action plan for antimicrobial resistance 2019 to 2024’, which commits to undertake research on antifungal resistance. In the last five years, the NIHR has invested more than £6 million in research into fungal infection and anti-microbial resistance is a priority for future research. However, it is not usual practice to ring-fence funds for particular topics or conditions. The Department works with other Government departments and funding agencies as well as the World Health Organization on the approach to antifungal resistance.

The Department’s National Institute for Health and Care Research (NIHR) welcomes funding applications for research into any aspect of human health, including fungal infection research. However, it is not usual practice to ring-fence funds for particular topics or conditions. Applications are subject to peer review and judged in open competition, with awards made on the basis of the importance of the topic to patients and health and care services, value for money and scientific quality. In the last five years, the NIHR has invested more than £6 million in research into fungal infection.

This information is not held in the format requested. However, the following table shows the number of person IDs with a primary diagnosis of fungal infection and finished admission episodes (FAEs) and finished consultant episodes (FCEs) where a main procedure took place in 2019/20 and 2020/21 in English National Health Service hospitals and English NHS commissioned activity in the independent sector.

Source: NHS Digital

Notes:

1. Person IDs. The Master Person Service (MPS) person identifier. This is a unique identifier for each individual patient, generated via the MPS. This identifier replaces the HESID field and allows an individual’s care to be tracked across years and continuous periods to be identified.
2. Primary Diagnosis. The primary diagnosis is the first of up to 20 (14 from 2002/03 to 2006/07 and seven prior to 2002/03) diagnosis fields in the Hospital Episode Statistics (HES) data set and provides the main reason why the patient was admitted to hospital.
3. ICD-10 coding and description. The following ICD-10 codes are indexed under the term ‘fungal infection’:

- B49.X Unspecified mycosis

- B20.5 HIV disease resulting in other mycoses

- B35.0 Tinea barbae and tinea capitis

- B35.1 Tinea unguium

- B35.2 Tinea manuum

- B35.3 Tinea pedis

- B35.6 Tinea cruris

- B36.9 Superficial mycosis, unspecified

- B48.7 Opportunistic mycoses

Research indicates that fungal infections are also known as mycosis, therefore the ICD-10 block B35-B49 Mycoses may be pertinent and has also been included in the data. It should be noted that there may be other codes within the ICD-10 classification which maybe applicable to the condition.

4. A FAE is the first period of admitted patient care under one consultant within one healthcare provider. FAEs are counted against the year or month in which the admission episode finishes. Admissions do not represent the number of patients, as a person may have more than one admission within the period.
5. A FCE is a continuous period of admitted patient care under one consultant within one healthcare provider. FCEs are counted against the year in which it ends. Figures do not represent the number of different patients, as a person may have more than one episode of care within the same stay in hospital or in different stays in the same year.
6. Main procedure. The first recorded procedure or intervention in each episode, usually the most resource intensive procedure or intervention performed during the episode. It is appropriate to use main procedure when looking at admission details, for example, time waited, while a more complete count of episodes with a particular procedure is obtained by looking at the main and the secondary procedures. It should be noted that some patients are treated for a fungal infection condition during an outpatient appointment. However, diagnoses are extremely seldom recorded in outpatient records, therefore it is not possible to provide useful data from the outpatient data set.
7. HES figures are available from 1989/90 onwards. Changes to the figures over time should be interpreted in the context of improvements in data quality and coverage particularly in earlier years, improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, apparent reductions in activity may be due to a number of procedures which may now be undertaken in outpatient settings and so no longer include in admitted patient HES data. Conversely, apparent increases in activity may be due to improved recording of diagnosis or procedure information.

Data is also held on total systemic antifungal prescribing in NHS hospital trusts recorded as defined daily doses (DDDs) per 1,000 admissions per day in 2020. The total consumption of antifungals in NHS acute trusts in 2020 was 0.63 DDDs per 1,000 admissions per day. This is a 21% increase in the rate of prescribing from 2019. The collection of the NHS England’s antifungal commissioning for quality and innovation data was interrupted by COVID-19.

Misuse and overuse of antimicrobials, such as fungal agents, is a factor in the development of drug-resistant pathogens. NHS England’s national pharmacy and prescribing clinical lead is supported by seven regional antimicrobial stewardship (AMS) leads. These AMS leads collaborate with regional National Health Service stakeholders and partner organisations, including infection prevention and control, patient safety, diagnostics and sepsis teams, the Department, the UK Health Security Agency (UKHSA), Health Education England and the Care Quality Commission, to contribute to multi-professional endeavours to mitigate the threat of antimicrobial resistance (AMR).

NHS England’s AMR diagnostics team advise that high-level research has been undertaken to understand the need for optimal fungal diagnostics and resistance testing. This has highlighted opportunities for improvement in data collection regarding the use of diagnostics, surveillance and consistent access to diagnostics.

The UKHSA reports on antifungal resistance against systemic antifungals utilised in the treatment of candidaemia, in the English Surveillance Programme for Antimicrobial Utilisation and Resistance report. Resistance to the key antifungals, amphotericin B, caspofungin and fluconazole, appears to have been decreasing in all Candida species. Fluconazole resistance decreased from 8.2% of Candida blood isolates tested in 2016 to 3.2% in 2020. Resistance to amphotericin B and caspofungin decreased slightly from 2016 to 2020, by 1.3% to 1.1%, and 3.4% to 3.3% respectively.

The most common invasive fungal infection in the United Kingdom is blood stream infection with yeast, often following surgical interventions. Public Health England (PHE) has prepared advisory documentation for national dissemination and individual hospital response following recent outbreaks caused by this organism, which can be viewed at the following link:

https://www.gov.uk/government/publications/candida-auris-emergence-in-england/candida-auris-within-the-united-kingdom-updated-guidance-published

Invasive mould infections such as invasive aspergillosis are more often seen in patients with haematological malignancies or those undergoing treatment for them, and it is difficult to capture absolute data on the incidence of these due to difficulty in definitive diagnosis.

Chronic yeast infections are frequently seen in females that have suffered recurrent bouts of vaginal candidosis (thrush). Estimates suggest that 70% of women report having had at least one episode whilst 8% have repeated and persistent infections. Dermatophyte infections, including athletes’ foot are extremely common, found in about 10% of the adult population at any one time. Scalp and nail infections with these organisms are more disfiguring and difficult to treat.