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scientificamerican.com

WHO Releases List of World's Most Dangerous

Superbugs

Helen Branswell,STAT

Pseudomonas aeruginosa is one bacterium on the WHO's list of highest priority needs for new
antibiotics. Credit: CDC Wikimedia

For the first time ever, the World Health Organization has drawn up a list of the highest
priority needs for new antibiotics marching orders, it hopes, for the pharmaceutical
industry.

The list, which was released Monday, enumerates 12 bacterial threats, grouping them into
three categories: critical, high, and medium.

Antibiotic resistance is growing and we are 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, said Dr. Marie-Paule Kieny, the WHOs assistant director-general for health systems
and innovation.

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The pipeline is practically dry.

Notably missing from the list is the bacterium that causes tuberculosis. That was not included,
Kieny said, because the need for new antibiotics to treat it has already been designated the
highest priority.

Kieny said the 12 bacteria were prioritized based on the level of drug resistance that already
exists for each, the numbers of deaths they cause, the frequency with which people become
infected with them outside of hospitals, and the burden these infections place on health care
systems.

Paradoxically, though, she and colleagues from the WHO could not provide an estimate of the
annual number of deaths attributable to antibiotic-resistant infections. The international
disease code system does not currently include a code for antibiotic-resistant infections; it is
being amended to include one.

The critical pathogens are ones that cause severe infections and high mortality in hospital
patients, Kieny said. While they are not as common as other drug-resistant infections, they
are costly in terms of health care resources needed to treat infected patients and in lives lost.

Three bacteria were listed as critical:

Acinetobacter baumannii bacteria that are resistant to important antibiotics called

carbapenems. Acinetobacter baumannii are highly-drug resistant bacteria that can cause
a range of infections for hospitalized patients, including pneumonia, wound, or blood
infections.

Pseudomonas aeruginosa, which are resistant to carbapenems. Pseudomonas aeruginosa

can cause skin rashes and ear infectious in healthy people but also severe blood
infections and pneumonia when contracted by sick people in the hospital.

Enterobacteriaceae a family of bacteria that live in the human gut that are resistant
to both carbepenems and another class of antibiotics, cephalosporins.

Six others were listed as high priority for new antibiotics. That grouping represents bacteria
that cause a large number of infections in otherwise healthy people. Included there is the
bacteria that causes gonorrhea, for which there are almost no remaining effective treatments.

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Hyacinth Empinado/STAT The superbugs are growing in number and strength.

Three other bacteria were listed as being of medium priority, because they are becoming
increasingly resistant to available drugs. This group includes Streptococcus pneumoniae that
is not susceptible to penicillin. This bacterium causes pneumonia, ear and sinus infections, as
well as meningitis and blood infections.

The creation of the list was applauded by others working to combat the rise of antibiotic
resistance.

This priority pathogens list, developed with input from across our community, is important
to steer research in the race against drug resistant infection one of the greatest threats to
modern health, said Tim Jinks, head of drug-resistant infections for the British medical
charity Wellcome Trust.

Within a generation, without new antibiotics, deaths from drug-resistant infection could
reach 10 million a year. Without new medicines to treat deadly infection, lifesaving
treatments like chemotherapy and organ transplant, and routine operations like caesareans
and hip replacements, will be potentially fatal.

The full list is:

Priority 1: Critical
1. Acinetobacter baumannii, carbapenem-resistant
2. Pseudomonas aeruginosa, carbapenem-resistant
3. Enterobacteriaceae, carbapenem-resistant, ESBL-producing

Priority 2: High
4. Enterococcus faecium, vancomycin-resistant
5. Staphylococcus aureus, methicillin-resistant, vancomycin-intermediate and resistant
6. Helicobacter pylori, clarithromycin-resistant
7. Campylobacter spp., fluoroquinolone-resistant
8. Salmonellae, fluoroquinolone-resistant
9. Neisseria gonorrhoeae, cephalosporin-resistant, fluoroquinolone-resistant

Priority 3: Medium
10. Streptococcus pneumoniae, penicillin-non-susceptible
11. Haemophilus influenzae, ampicillin-resistant
12. Shigella spp., fluoroquinolone-resistant

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Republished with permission from STAT. This article originally appeared on February 27,
2017

Helen Branswell

Helen Branswell is STAT's infectious diseases and public health reporter. She comes from the
Canadian Press, where she was the medical reporter for the past 15 years. Helen cut her
infectious diseases teeth during Toronto's SARS outbreak in 2003 and spent the summer of
2004 embedded at the US Centers for Disease Control and Prevention. In 2010-11 she was a
Nieman Global Health Fellow at Harvard, where she focused on polio eradication. Warning:
Helen asks lots of questions.

Credit: Nick Higgins

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