WHO Publishes First List of Bacteria Where New Antibiotics 'Urgently Needed'

"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," said Dr. Marie-Paule Kieny, WHO's assistant director-general for Health Systems and Innovation.

The World Health Organization on Feb. 27 published its first-ever list of antibiotic-resistant "priority pathogens," as the UN agency termed them – 12 families of bacteria that pose the greatest threat to human health. The list was created as a way to guide and promote research and development of new antibiotics as part of WHO's efforts to address growing global resistance to antimicrobial medicines, and it highlights the threat of gram-negative bacteria that are resistant to multiple antibiotics.

"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 critical, high, and medium priority needs. 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). These can cause severe and often deadly infections, such as bloodstream infections and pneumonia, and have become resistant to a large number of antibiotics, including carbapenems and third-generation cephalosporins, according to WHO's announcement.

It says the high and medium priority categories contain other increasingly drug-resistant bacteria that cause more common diseases and food poisoning caused by salmonella. G20 health experts are meeting this week in Berlin, Germany, and Hermann Gröhe, federal Minister of Health for that country, agreed that "We need effective antibiotics for our health systems. We have to take joint action today for a healthier tomorrow. Therefore, we will discuss and bring the attention of the G20 to the fight against antimicrobial resistance. WHO's first global priority pathogen list is an important new tool to secure and guide research and development related to new antibiotics."

Tuberculosis – its resistance to traditional treatment has been growing – isn't on the list because it is targeted by other, dedicated programs, and bacteria such as streptococcus A and B with low levels of resistance to existing treatments are not because they don't currently pose a significant public health threat, according to WHO, which reported 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; how many treatment options remain; and whether new antibiotics to treat them are already in the R&D pipeline.

"New antibiotics targeting this priority list of pathogens will help to reduce deaths due to resistant infections around the world," said Professor Evelina Tacconelli, head of the Division of Infectious Diseases at the university and a major contributor to development of the list. "Waiting any longer will cause further public health problems and dramatically impact on patient care."

The WHO list:

Priority 1: CRITICAL

  • Acinetobacter baumannii, carbapenem-resistant
  • Pseudomonas aeruginosa, carbapenem-resistant
  • Enterobacteriaceae, carbapenem-resistant, ESBL-producing

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

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