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Antimicrobial resistance (AMR) is a significant public health threat. According to the German Center for Infection Research, an estimated 4.95 million deaths worldwide in 2019 were directly or indirectly linked to infections caused by resistant bacteria. In May 2024, the World Health Organization (WHO) updated its Bacterial Priority Pathogens List (BPPL).

In The Lancet Infectious Diseases, Hatim Sati, MD, from the WHO’s Division of Antimicrobial Resistance in Geneva, Switzerland, and his team, on behalf of the WHO BPPL Advisory Group, outlined the processes that led to the revision of the 2017 WHO BPPL, resulting in the updated 2024 version. The 2017 BPPL was crucial in raising awareness about antibiotic resistance and remains a vital tool for prevention and control.

Since the release of the 2017 BPPL, 13 new antibiotics have been approved. However, AMR continues to rise, with many pathogens now showing resistance to most of the newer antibiotics.

Sati and his team employed methods similar to those used for the 2017 BPPL but expanded the factors used to evaluate each pathogen. They incorporated more robust quantitative data to assess pathogens based on disease burden, resistance trends, and public health impact. They also considered qualitative criteria, including the preventability of infections through vaccination or other measures, transmission dynamics, and treatability. The authors emphasized the disparities in pathogen burden and access to treatment between high-income and low- and middle-income countries.

Critical Concern: Carbapenem-Resistant Klebsiella pneumoniae

Sati and his team evaluated 24 antibiotic-resistant bacterial pathogens using eight criteria: Mortality, nonfatal burden, incidence, 10-year resistance trends, preventability, transmissibility, treatability, and antibacterial pipeline status. The pathogens were categorized into three priority levels: critical (highest quartile), high (middle quartile), and medium (lowest quartile).

• Carbapenem-resistant K pneumoniae scored the highest, with 84%.
• Antibiotic-resistant gram-negative bacteria, including K pneumoniae, Acinetobacter spp., and Escherichia coli, as well as rifampicin-resistant Mycobacterium tuberculosis, ranked in the highest quartile.
• Among bacteria commonly responsible for community-acquired infections, the highest scores were observed for fluoroquinolone-resistant Salmonella enterica serotype Typhi (72%), Shigella spp. (70%), and Neisseria gonorrhoeae (64%).
• Other significant pathogens on the list include Pseudomonas aeruginosa and Staphylococcus aureus.
• At the bottom of the list were penicillin-resistant group B streptococci, with 28%. 

Urgent Action Needed

Sati and his colleagues stressed that the WHO BPPL 2024 is a crucial tool for prioritizing research and development investments and guiding global health policy measures to combat antibiotic resistance. Gram-negative bacteria and rifampicin-resistant M tuberculosis remain critical priority pathogens.

The authors emphasized that “Focused efforts and sustained investments in novel antibacterials are needed to address AMR priority pathogens, which include high-burden antibiotic-resistant bacteria such as Salmonella and Shigella spp., N gonorrhoeae, and S aureus.”

Sati and his team also highlighted the need to expand equitable access to existing medications, improve vaccine availability, and strengthen infection-prevention measures as part of efforts to combat these pathogens.

Better Prevention

In an accompanying commentary, David P. Moore, MD, PhD, from the School of Clinical Medicine at the University of the Witwatersrand in Johannesburg, South Africa, noted that a vaccine against K pneumoniae is currently under development. Strategies are also being explored to shorten the duration of antibiotic treatments and hospital stays for various infectious syndromes.

Moore emphasized that, alongside research, the focus should be on optimizing prevention strategies — hand hygiene being the most fundamental. “Although there is a dearth of high-quality evidence on how optimization of infection prevention and control measures might affect the burden, incidence, and health-care costs of hospital-associated infections, the onus is on all health-care workers to minimize the potential for transmission of AMR organisms from our hands to our patients,” wrote Moore.

This story was translated from Medscape’s German edition.