Perspective from Vance Garrison Fowler, MD
February 27, 2017
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WHO releases list of ‘priority pathogens’ in urgent need of new antibiotics

Perspective from Vance Garrison Fowler, MD
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Today, WHO released its first-ever list of antibiotic-resistant “priority pathogens” that pose the greatest threat to human health. The list is intended to promote research and development of new antibiotic treatments.  

“This list is a new tool to ensure R&D responds to urgent public health needs,” Marie-Paule Kieny, PhD, the WHO assistant director-general for health systems and innovation, said in a news release. “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.”

Marie-Paule Kieny
Marie-Paule Kieny

The list is divided into three categories that are based on how urgent the need is for new treatment options.

Top priority pathogens with a “critical” need for R&D include:

Secondary priority pathogens with a “high” need for R&D include:

  • vancomycin-resistant Enterococcus faecium;
  • methicillin-resistant, vancomycin-intermediate and resistant Staphylococcus aureus;
  • clarithromycin-resistant Helicobacter pylori;
  • fluoroquinolone-resistant Campylobacter spp.;
  • fluoroquinolone-resistant Salmonellae; and
  • cephalosporin- and fluoroquinolone-resistant Neisseria gonorrhoeae.

Other priority pathogens with a “medium” need for R&D include:

  • penicillin–non-susceptible Streptococcus pneumoniae;
  • ampicillin-resistant Haemophilus influenzae; and
  • fluoroquinolone-resistant Shigella spp.

U.S. Centers for Disease Control and Prevention - Medical Illustrator
3-D computer-generated image of multidrug-resistant Acinetobacter spp. bacteria, which WHO named as one of the top "priority pathogens" in need of new antiboitics. 
Source: U.S. Centers for Disease Control and Prevention - Medical Illustrator

WHO selected these pathogens in collaboration with the division of infectious diseases at the University of Tübingen, Germany, using a multicriteria decision analysis technique that took into consideration how deadly the infections that the pathogens cause are; whether treatment requires long hospital stays; the frequency of resistance; how transmissible they are; whether the infections can be prevented; how many treatment options are available; and whether new antibiotics are already in the pipeline. Although multidrug-resistant tuberculosis has been increasing in recent years, WHO stated that it was not included on the list because there are other programs dedicated to combatting it.

In October, the Infectious Diseases Society of America (IDSA) sent WHO its own recommendations for which pathogens should be included on the list. The organization stated that A. baumannii — which landed first on WHO’s “critical” need list — was “a particularly worrisome threat” and a major cause of health care-associated infections that are becoming “increasingly common” in ICUs.

“We are pleased to see that WHO identified three carbapenem-resistant pathogens (Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae) that IDSA recommended as the highest priorities, and agree the list largely reflects the areas of greatest unmet needs, with remaining treatment options and pipeline drugs as key criteria for prioritization,” a recent IDSA statement said. “Congress must enact incentives for antibiotic research and development that include tax credits and provide robust funding for federal agencies working on antibiotic research and development, including the National Institute of Allergy and Infectious Diseases, the Biomedical Advanced Research and Development Authority and the Department of Defense.”

IDSA also praised WHO on stating that there must be more appropriate use of antibiotics in humans and animals, reflecting a One Health approach.

“We look forward to continued One Health efforts with our U.S. and international partners, including WHO, on antimicrobial stewardship, infection prevention, improved surveillance, diagnostics & vaccines R&D, and investment in the infectious diseases workforce," the statement said. 

Later this week in Berlin, health exerts affiliated with the G-20 will discuss their efforts in targeting the priority pathogens, Hermann Grὂhe, the federal minister of health in Germany, said in the WHO news release.

“We have to take joint action today for a healthier tomorrow,” he said. “Therefore, we will discuss and bring the attention of the G-20 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.”

Disclosure: Infectious Disease News was unable to confirm relevant financial disclosures at the time of publication.