Source: Michael Fielding, MEATINGPLACE, 3/3/17


The World Health Organization (WHO) has published its first-ever list of antibiotic-resistant "priority pathogens" — a catalog of 12 families of bacteria that pose the greatest threat to human health.

The list was drawn up in a bid to guide and promote research and development of new antibiotics as part of WHO’s efforts to address growing global resistance to antimicrobial medicines. It highlights in particular the threat of gram-negative bacteria that are resistant to multiple antibiotics. Those 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," said Dr. Marie-Paule Kieny, WHO's assistant director-general for health systems and innovation. "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 need for new antibiotics: critical, high and medium-priority.

The most critical group 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.

Those 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 — ontain other increasingly drug-resistant bacteria that cause more common diseases such as food poisoning caused by campylobacter and salmonella.

Antimicrobial resistance remains high, says EU report

The release of the list comes on the heels of the latest report on antimicrobial resistance (AMR) in bacteria from the European Center for Disease Prevention and Coltrol (ECDC) and the European Food Safety Authority (EFSA) underlining the serious threat AMR poses to public and animal health. Infections caused by bacteria that are resistant to antimicrobials lead to about 23,000 deaths annually in the United States and 25,000 deaths in the EU every year.

“Antimicrobial resistance is an alarming threat putting human and animal health in danger. We have put substantial efforts to stop its rise, but this is not enough. We must be quicker, stronger and act on several fronts,” said Vytenis Andriukaitis, EU commissioner for health and food safety.

The report shows that in general, multi-drug resistance in salmonella bacteria is high across the EU. However, experts note that resistance to critically important antimicrobials used to treat severe human cases of salmonella infection remains low.

Meanwhile, the Centers for Disease Control and Prevention (CDC) has deemed drug-resistant campylobacter and two types of drug-resistant salmonella among the threats it considered “serious,” comparable to the EU’s high-priority category. Non-typhoidal Salmonella, for example, causes 100,000 drug-resistant infections annually in the United States; drug-resistant campylobacter causes more than 300,000 drug-resistant infections annually and leads to an average of 120 deaths.

“It is of particular concern that some common types of salmonella in humans, such as monophasic Salmonella Typhimurium, exhibit extremely high multi-drug resistance,” said Mike Catchpole, chief scientist at ECDC. “Prudent use of antibiotics in human and veterinary medicine is extremely important to address the challenge posed by antimicrobial resistance. We all have a responsibility to ensure that antibiotics keep working.”

The WHO list release this week 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.

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