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BACTERIAL PATHOGENS PRIORITY LIST

21st May, 2024

BACTERIAL PATHOGENS PRIORITY LIST

Source: CIDRAP

Disclaimer: Copyright infringement not intended.

Context

  • The World Health Organization (WHO) has updated its Bacterial Pathogens Priority List (BPPL) for the first time since 2017.
  • This list is crucial for guiding research and development (R&D) efforts, antimicrobial resistance (AMR) surveillance, and infection prevention strategies.

Details

Categories and Criteria

  • The updated BPPL categorizes 24 pathogens and 15 "drug-bug" combinations into critical, high, and medium priority groups. These categories are based on eight criteria:
  1. Mortality
  2. Incidence
  3. Non-fatal health burden
  4. Trend of resistance
  5. Transmissibility
  6. Preventability in healthcare and community settings
  7. Treatability
  8. Number of antibiotics in the pipeline

Critical Priority Pathogens

Characteristics

  • High Threat:Limited treatment options, high morbidity and mortality, and ability to share resistance mechanisms.
  • Focus:Primarily gram-negative bacterial pathogens found in hospitals. 

Key Pathogens

  • Gram-Negative Bacteria:
    • Resistant to carbapenems and third-generation cephalosporins.
    • Examples: Acinetobacter baumanniiPseudomonas aeruginosaEnterobacteriaceae(including Klebsiella pneumoniae, Escherichia coli).
    • Third-Generation Cephalosporin-Resistant Enterobacterales (3GCRE): Notable for high rates of treatment failure, especially in neonatal sepsis.
  • Mycobacterium tuberculosis:
    • Resistant to Rifampicin, a key antibiotic for tuberculosis treatment.
    • Rifampicin-Resistant Tuberculosis (RR-TB): Newly added due to diagnostic and treatment challenges.

High Priority Pathogens

Characteristics

  • Substantial Burden:Difficult to treat, cause significant disease burden, particularly in low- and middle-income countries, and increasing resistance.
  • Community Pathogens:More emphasis on pathogens causing community-acquired infections.
  • Healthcare Challenges:Pose major issues in hospital and healthcare settings.

Key Pathogens

  • Methicillin-Resistant Staphylococcus aureus (MRSA)
  • Vancomycin-Resistant Enterococcus faecium
  • Fluoroquinolone-Resistant Shigella: Moved from medium to high priority due to increasing resistance.
  • Fluoroquinolone-Resistant Salmonella Typhi: Leading cause of typhoid fever with significant global health impact.
  • Fluoroquinolone-Resistant Non-Typhoidal Salmonella: Leading cause of foodborne illness with growing resistance concerns.
  • Third-Generation Cephalosporin-Resistant and/or Fluoroquinolone-Resistant Neisseria gonorrheae
  • Pseudomonas aeruginosa:Also listed under critical for some strains.

Medium Priority Pathogens

Characteristics

  • Increasing Resistance:Pose significant challenges in vulnerable populations and low- and middle-income countries (LMICs).

Key Pathogens

  • Macrolide-Resistant Group A Streptococci
  • Penicillin-Resistant Group B Streptococci
  • Macrolide-Resistant Streptococcus pneumoniae
  • Ampicillin-Resistant Haemophilus influenzae
  • Neisseria gonorrhoeae

Notable Changes and New Additions

New Additions

  • Macrolide-Resistant Group A Streptococci
  • Penicillin-Resistant Group B Streptococci
  • Macrolide-Resistant Streptococcus pneumoniae

Notable Removals

  • Clarithromycin-Resistant Helicobacter pylori
  • Fluoroquinolone-Resistant Campylobacter spp
  • Penicillin-Non-Susceptible Streptococcus pneumoniae
  • Third-Generation Cephalosporin-Resistant Providencia spp
  • Vancomycin-Intermediate and -Resistant Staphylococcus aureus

Implications

Public Health and R&D

  • Community Pathogens:Increased recognition of community-acquired pathogens highlights the need for public health and R&D focus.
  • Global Health Burden:Emphasizes the need for ongoing surveillance, research, and targeted interventions, especially in LMICs.

Investment and Strategy

  • Guiding Investment:The updated list aims to direct investments towards the most pressing threats and critical needs in antibiotic development.
  • Infection Control:Enhanced focus on preventing the spread of resistant pathogens in healthcare and community settings.

WHO Recommendations

  • Research and Development:
    • Invest in the development of new antibiotics, diagnostics, and vaccines.
    • Promote alternative treatments and prevention strategies.
  • Surveillance and Monitoring:
    • Strengthen global surveillance systems to track resistance patterns and emerging threats.
    • Enhance data sharing and collaboration among countries.
  • Antimicrobial Stewardship:
    • Implement robust antimicrobial stewardship programs to optimize the use of existing antibiotics.
    • Educate healthcare providers and the public on the appropriate use of antimicrobials.
  • Infection Prevention and Control:
    • Improve infection control measures in healthcare facilities.
    • Promote hygiene and sanitation practices in communities.

Sources:

CIDRAP

PRACTICE QUESTION

Q.  The updated Bacterial Pathogens Priority List by the WHO underscores the urgent need for global action to combat antibiotic resistance. Comment. (150 Words)