WHO Publishes First List of 'Priority' Pathogens

Posted March 02, 2017

Dr Marie-Paule Kieny, assistant director-general for health systems and innovation at WHO, said of the list's goal, "This list is a new tool to ensure research and development responds to urgent public needs". However, this is the first time that a list has been produced by a global health agency from the point of view of threat to worldwide public health. The critical priority group includes Acinetobacter, Pseudomonas, and various Enterobacteriaceae, such as Klebsiella, E. coli, Serratia, and Proteus, which can cause severe and often deadly infections. This risk is measured based on the resistance the bacteria is having in that particular moment, as well as its current mortality rate and prevalence demonstrated within communities.

Topping the list were bacteria classed as "gram negative" bacteria, which have already shown resistance to multiple drugs. Bacteria in this category cause infections that are less deadly than the three critical-level bugs, but they are much more widespread. Other bacteria that were not included, such as streptococcus A and B and chlamydia, have low levels of resistance to existing treatments and do not now pose a significant public health threat.

The WHO list is divided into three categories, according to the urgency of need for new antibiotics: critical, high and medium priority. And resistant Enterobacteriaceae are an especially unsafe kind of superbug, because many of these bacteria are quickly learning to repel just about every drug we have available against them.

The second and third groups name bacteria that are increasingly showing resistance against the main drugs used against them, but which still have a few options remaining.

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The top three bacteria have been known to resist multiple antibiotics, including carbapenems, which are now the strongest and most effective drugs against resistance.

World Health Organization said the most-needed drugs are for germs that threaten hospitals, nursing homes and among patients who need ventilators or catheters. TOI had reported the case of an elderly American woman who died in the United States recently after having contracted an infection while being treated for a thigh bone fracture in India two years ago. Da Silva said those codes are being revised. Consequently, only a handful of new antibiotics have entered the market in the past 10 years. "We need effective antibiotics for our health systems". The reasons for this are both scientific and financial.

In a world awash in antibiotics, risky infections are getting even harder to fight.

In simple terms, the main cause of this scary trend is that we've been taking too many antibiotics and using them widely to grow livestock for food in mainly developed countries.

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As a result, there is little financial incentive to develop new antibiotics. Although the total number of Enterobacteriaceae infections was fairly stable year to year, the proportion of these infections that were resistant to antibiotics rose from 0.2 percent in 2007 to 1.5 percent in 2015. But they also acknowledge that governments need to create policies that spur the public and private sectors to invest in research and development. The list aims to encourage and mobilize innovators to conduct research and development on new antibiotics. In return, those companies would have to ensure that the new antibiotic is available when necessary but not overused.

Kieny says a proposal has been made to establish a $2 billion innovation fund. So far, the United Kingdom and China have pledged $72 million to that fund.

"Carbapenems are our go-to antibiotics, used in the most critically ill patients", Fowler said. This is carbapenem-resistant, ESBL-producing strains that can cause serious infections in the lungs, blood, and urine.

The issue is compounded by the fact that sick Americans are overusing antibiotics, even when the prescriptions can't help them. According to Dr. Nicola Magrini, a member of the World Health Organization department of innovation, access and use of essential medicines, this could potentially be due to their reduced cost and easier development.

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