To provide guidance on new and necessary treatments to halt the spread of antimicrobial resistance, the World Health Organization has released an updated Bacterial Priority Pathogens List (BPPL) 2024, which features 15 families of antibiotic-resistant bacteria.
AMR occurs when bacteria, viruses, fungi and parasites no longer respond to medicines, making people sicker and increasing the risk of disease spread, illness and deaths. AMR is driven in large part by the misuse and overuse of anti-microbials. The updated list incorporates new evidence and expert insights to guide R&D for new antibiotics and promote international coordination to foster innovation, the UN health body said.
“By mapping the global burden of drug-resistant bacteria and assessing their impact on public health, this list is key to guiding investment and grappling with the antibiotics pipeline and access crisis,” said Yukiko Nakatani, WHO’s assistant director-general for antimicrobial resistance.
The critical priority pathogens, such as gram-negative bacteria resistant to last-resort antibiotics, and mycobacterium tuberculosis (that causes TB) resistant to the antibiotic rifampicin, present major global threats due to their high burden, and ability to resist treatment and spread resistance to other bacteria. Gram-negative bacteria have built-in abilities to find new ways to resist treatment and can pass along genetic material that allows other bacteria to become drug resistant as well, said WHO.
High priority pathogens, such as salmonella (bacteria that causes diarrhoea, fever and stomach pains) and shigella (causing intestinal infection), are of particularly high burden in low- and middle-income countries, along with pseudomonas aeruginosa (causes pneumonia) and staphylococcus aureus (causes skin infection), which pose significant challenges in health care.
Other high priority pathogens, such as antibiotic-resistant neisseria gonorrhoeae (causes gonorrhoea) and enterococcus faecium (causes bloodstream infection), present unique public health challenges, including persistent infections and resistance to multiple antibiotics, necessitating targeted research and public health interventions.
Medium priority pathogens include Group A and B streptococci (throat and intestinal infections), streptococcus pneumonia (causes pneumonia)) and haemophilus influenza (casues meningitis), which present a high disease burden. These pathogens require increased attention, especially in vulnerable populations including paediatric and elderly populations, particularly where resources are limited.
“Antimicrobial resistance jeopardizes our ability to effectively treat high burden infections, such as tuberculosis, leading to severe illness and increased mortality rates,” said Jerome Salomon, WHO’s assistant director-general for universal health coverage, communicable and non-communicable diseases.
The UN health body also said the list emphasizes the need for a comprehensive public health approach to addressing AMR, including universal access to quality and affordable measures for prevention, diagnosis and appropriate treatment of infections. “This is crucial for mitigating AMR’s impact on public health and the economy,” it said.
The BPPL 2024 has third-generation cephalosporin-resistant Enterobacterales (causes UTI) listed as a stand- alone item within the critical priority category that emphasizes their burden and need for targeted interventions, especially in low- and middle-income countries.
Carbapenem-resistant pseudomonas aeruginosa (causes pneumonia and blood infection) infection moving from critical to high priority in BPPL 2024 mirrors recent reports of decreases in global resistance. Despite this transition, investment in R&D and other prevention and control strategies for this infection remains important, given its significant burden in some regions.
“Changes since 2017 reflect the dynamic nature of AMR, necessitating tailored interventions. Building on the value of the BPPL as a global tool, tailoring the list to country and regional contexts can account for regional variations in pathogen distribution and the AMR burden,” the WHO said.
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