The World Health Organization (WHO) has published its new list of priority bacterial pathogens for 2024, which includes 15 families of antibiotic-resistant bacteria classified into three categories (critical, high and medium) to facilitate priority setting. This list provides guidance for obtaining new treatments that are necessary to stop the spread of antimicrobial resistance.
Yukiko Nakatani, WHO Acting Assistant Director-General for Antimicrobial Resistance, noted that to develop the list of priority bacterial pathogens, the global burden of infections due to drug-resistant bacteria was determined and their impact on public health was analyzed. Therefore, this list is essential to guide investment and overcome obstacles to obtaining and accessing new antibiotics. The threat of antimicrobial resistance has increased since the publication of the first list in 2017, which undermines the effectiveness of many antibiotics and can undo many achievements of modern medicine.
Critical priority pathogens, such as Gram-negative bacteria resistant to last-resort antibiotics and Mycobacterium tuberculosis resistant to the antibiotic rifampicin, are highly dangerous threats worldwide due to the incidence of the diseases they cause and their ability to resist treatments and transmit resistance to other bacteria. Gram-negative bacteria can find new ways to resist treatments and transfer genetic material to other bacteria that makes them also resistant.
High-priority pathogens such as Salmonella and Shigella cause high morbidity and mortality in low- and middle-income countries, as do Pseudomonas aeruginosa and Staphylococcus aureus, which cause significant problems in healthcare facilities.
Other high-priority pathogens, such as drug-resistant Neisseria gonorrhoeae and Enterococcus faecium, pose specific public health problems, such as persistent infections and resistance to several antibiotics, and therefore require public health interventions and specific studies.
Medium priority pathogens include group A and B streptococci (which have been added to the list in 2024), Streptococcus pneumoniae and Haemophilus influenzae, which lead to a high burden of disease. These pathogens rThey require greater surveillance, especially in vulnerable populations, such as children and the elderly, especially in places with few resources.
Jérôme Salomon, Assistant Director-General of the WHO for Universal Health Coverage/Communicable and Non-Communicable Diseases, assures that antimicrobial resistance “puts in check our ability to effectively treat infections that cause a lot of morbidity and mortalitysuch as tuberculosis, leading to serious illness and increased mortality rates.”
The 2024 list also emphasizes the need for a comprehensive public health approach to addressing antimicrobial resistance, including universal access to quality and affordable measures to prevent, diagnose and correctly treat infections, as outlined in the WHO people-centred approach to combating antimicrobial resistance and the core package of interventions in this area, which is essential to mitigate the impact of Antimicrobial resistance in public health and the economy.
Modifications
Five pathogen-antibiotic combinations included in the 2017 list have been removed from the 2024 list and four new combinations have been added. Enterobacteriaceae resistant to third-generation cephalosporins appear in a separate group within the critical priority category, highlighting their burden of morbidity and mortality and the need for specific interventions to address them, especially in low-income countries. and medium.
Additionally, carbapenem-resistant Pseudomonas aeruginosa infection has been moved from the critical category to high priority to reflect recent reports showing declining resistance globally. Despite this, it is still important to invest in R&D and other prevention and control strategies for this infection, given the high burden it represents in some regions.
The WHO list of priority bacterial pathogens for 2024 includes these bacteria as critical priority: Acinetobacter baumannii resistant to carbapenems Enterobacteriales resistant to third-generation cephalosporins Enterobacteriales resistant to carbapenems. Rifampicin-resistant Mycobacterium tuberculosis (which has been included after carrying out an independent analysis with parallel adapted criteria and after the subsequent application of an adapted analysis matrix to decide based on several criteria).
As High priority: Salmonella Typhi resistant to fluoroquinolones; Shigella spp. resistant to fluoroquinolones; Vancomycin-resistant Enterococcus faecium: Carbapenem-resistant Pseudomonas aeruginosa; Non-typhoid salmonellae resistant to fluoroquinolones; Neisseria gonorrhoeae resistant to third generation cephalosporins and/or fluoroquinolones; Methicillin-resistant Staphylococcus aureus
As medium priority: Macrolide-resistant group A streptococci; Macrolide-resistant Streptococcus pneumoniae; Ampicillin-resistant Haemophilus influenzae; Macrolide-resistant group B streptococci
