World Health Organization (WHO) published its first-ever list of antibiotic-resistant “priority pathogens” – a catalogue of 12 families of bacteria that pose the greatest threat to human health. According to WHO, the list was drawn up in a bid to guide and promote research and development (R&D) of new antibiotics, as part of WHO’s efforts to address growing global resistance to antimicrobial medicines.
The list highlights in particular the threat of gram-negative bacteria that are resistant to multiple antibiotics. These 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.
“This list is a new tool to ensure R&D responds to urgent public health needs,” says Dr. Marie-Paule Kieny, WHO’s Assistant Director-General for Health Systems and Innovation. (glasshousefarms.org) “Antibiotic resistance is growing, and we are fast running out of treatment options. If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time.”
The WHO list is divided into three categories according to the urgency of the need for new antibiotics: critical, high, and medium priority.
Table of Contents
WHO priority pathogens list for R&D of new antibiotics 2017
Priority 1: CRITICAL
- Streptococcus pneumoniae, penicillin-non-susceptible
- Haemophilus influenzae, ampicillin-resistant
- Shigella spp., fluoroquinolone-resistant
Priority 2: HIGH
- Enterococcus faecium, vancomycin-resistant
- Staphylococcus aureus, methicillin-resistant, vancomycin-intermediate and resistant
- Helicobacter pylori, clarithromycin-resistant
- Campylobacter spp., fluoroquinolone-resistant
- Salmonellae, fluoroquinolone-resistant
- Neisseria gonorrhoeae, cephalosporin-resistant, fluoroquinolone-resistant
Priority 3: MEDIUM
- Streptococcus pneumoniae, penicillin-non-susceptible
- Haemophilus influenzae, ampicillin-resistant
- Shigella spp., fluoroquinolone-resistant
The most critical group of all includes multidrug-resistant bacteria that pose a particular threat in hospitals, nursing homes, and among patients whose care requires devices such as ventilators and blood catheters. They include Acinetobacter, Pseudomonas, and various Enterobacteriaceae (including Klebsiella, E. coli, Serratia, and Proteus). They can cause severe and often deadly infections such as bloodstream infections and pneumonia.
These bacteria have become resistant to a large number of antibiotics, including carbapenems and third-generation cephalosporins – the best available antibiotics for treating multi-drug resistant bacteria.
The second and third tiers in the list – the high and medium priority categories – contain other increasingly drug-resistant bacteria that cause more common diseases such as gonorrhea and food poisoning caused by salmonella.
According to WHO, the list was developed in collaboration with the Division of Infectious Diseases at the University of Tübingen, Germany, using a multi-criteria decision analysis technique vetted by a group of international experts. The criteria for selecting pathogens on the list were:
- how deadly the infections they cause are; whether their treatment requires long hospital stays;
- how frequently they are resistant to existing antibiotics when people in communities catch them;
- how easily they spread between animals, from animals to humans, and from person to person;
- whether they can be prevented (e.g. through good hygiene and vaccination);
- how many treatment options remain; and
- whether new antibiotics to treat them are already in the R&D pipeline.
For more information: Read the WHO press release here
Updates of BPPL (Bacterial Priority Pathogens List), 2024
According to Dr Yukiko Nakatani, WHO’s Assistant Director-General for Antimicrobial Resistance ad interim, the threat of antimicrobial resistance has increased significantly since the last list in 2017. The danger can decrease the efficacy of antibiotics and damage modern medicines.
The most alarming updates are the inclusion of Enterobacteriaceae resistant to third-generation cephalosporins, the last-resort antibiotics, and rifampicin-resistant Mycobacterium tuberculosis (RR-TB) in the critical group. A positive change is the reclassification of carbapenem-resistant Pseudomonas aeruginosa from the critical group to the high group. However, this does not imply that the threat of carbapenem-resistant Pseudomonas aeruginosa has diminished.
The WHO BPPL 2024 includes the following bacteria:
Critical priority
- Acinetobacter baumannii, carbapenem-resistant;
- Enterobacterales, third-generation cephalosporin-resistant, and
- Enterobacterales, carbapenem-resistant;
- Mycobacterium tuberculosis is rifampicin-resistant (included after an independent analysis with parallel tailored criteria and subsequent application of an adapted multi-criteria decision analysis matrix).
High priority
- Salmonella Typhi, fluoroquinolone-resistant
- Shigella spp., fluoroquinolone-resistant
- Enterococcus faecium, vancomycin-resistant
- Pseudomonas aeruginosa, carbapenem-resistant
- Non-typhoidal Salmonella, fluoroquinolone-resistant
- Neisseria gonorrhoeae, third-generation cephalosporin- and/or fluoroquinolone-resistant
- Staphylococcus aureus, methicillin-resistant
Medium priority
- Group A streptococci, macrolide-resistant
- Streptococcus pneumoniae, macrolide-resistant
- Haemophilus influenzae, ampicillin-resistant
- Group B streptococci, penicillin-resistant
In the BPPL 2024, five pathogen-antibiotic combinations that were previously present in BPPL 2017 have been removed. The separate entry of third generation cephalosporin-resistant Enterobacteriaceae in the critical group underscores the critical need to invest in research, particularly in low and middle income countries, to combat this growing threat.
For further information, Read WHO Bacterial Priority Pathogens List, 2024: bacterial pathogens of public health
importance to guide research, development and strategies to prevent and control antimicrobial resistance.
Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO.
