Source: CIDRAP

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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 baumannii, Pseudomonas aeruginosa, Enterobacteriaceae(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)