Biological Hazard – Antibiotic resistant Superbugs: High Priority Pathogens, WHO
ANTIBIOTIC RESISTANCE (02): WHO, PRIORITY PATHOGENS
Published Date: 2017-03-01 09:01:27
Subject: PRO/EDR> Antibiotic resistance (02): WHO, priority pathogens
Archive Number: 20170301.4871299
 Date: Mon 27 Feb 2017
Source: Washington Post [edited]
The World Health Organization announced its 1st list of antibiotic-resistant “priority pathogens” on [Mon 27 Feb 2017], detailing 12 families of bacteria that agency experts say pose the greatest threat to human health and kill millions of people every year.
The list is divided into 3 categories, prioritized by the urgency of the need for new antibiotics. The purpose is to guide and promote research and development of new drugs, officials said. Most of the pathogens are among the nearly 2-dozen antibiotic-resistant microbes that the US Centers for Disease Control and Prevention warned in a 2013 report could cause potentially catastrophic consequences if the United States didn’t act quickly to combat the growing threat of antibiotic-resistant infections.
“This list is not meant to scare people about new superbugs,” said Marie-Paule Kieny, an assistant director-general at WHO. “It’s intended to signal research and development priorities to address urgent public health threats.”
Superbugs that the WHO considers the highest priority are responsible for severe infections and high mortality rates, especially among hospitalized patients in intensive care or using ventilators and blood catheters, as well as among transplant recipients and people undergoing chemotherapy. While these pathogens are not widespread, “the burden for society is now alarming,” she said.
Included in this highest-priority group are, CRE or carbapenem-resistant Enterobacteriaceae, which US health officials have dubbed “nightmare bacteria.” In some instances, it kills up to 50 percent of patients who become infected. An elderly Nevada woman who died last year  contracted an infection caused by CRE that was resistant to all 26 antibiotics available in the United States.
Also in the 1st-tier group is _Acinetobacter baumannii_; the infections tied to it typically occur in ICUs and settings with very sick patients. The other bacteria tagged as a critical priority: _Pseudomonas aeruginosa_, which can be spread on the hands of health-care workers or by equipment that gets contaminated and is not properly cleaned.
The list’s 2nd and 3rd tiers — the high and medium priority categories — cover bacteria that cause more common diseases, such as gonorrhea [that is caused by _Neisseria gonorrhoeae_] and food poisoning caused by _Salmonella_. While not associated with significant mortality rates, “they have a dramatic health and economic impact, particularly in low-income countries,” Kieny said.
Although there has been renewed interest and research investment in antibiotics because of the growing threat that antibiotic resistance poses, much of the work is more focused on antibiotics with a broad range, she said. “We have to focus specifically for a much smaller range of bacteria,” targeting the 3 highest-priority pathogens, Kieny said.
Drug companies have also tended to focus more on Gram-positive bacteria that tend to colonize the skin of healthy individuals and generate less resistance, said Evelina Tacconelli, who heads the infectious diseases division at the University of Tübingen in Germany, which helped develop the WHO list. By comparison, Gram-negative bacteria more frequently colonize intestinal reservoirs and can cause sepsis and severe urinary tract infections, especially among elderly patients.
There have been no new classes of antibiotics discovered that have made it to market since 1984, according to the Pew Charitable Trust’s antibiotic-resistance project. And there aren’t enough drugs in the pipeline to meet future needs, Allan Coukell, senior director of health programs at Pew, said [Mon 27 Feb 2017].
Of the 40 antibiotics in clinical development in the United States, “fewer than half even have the potential to treat the pathogens identified by WHO,” he said. “And based on history, most of those will fail to reach the clinic for reasons of efficacy or safety. So the outlook is grim.”
Historical data show that generally only 1 of 5 drugs that reach the initial phase of testing in humans will receive approval from the Food and Drug Administration. Developing antibiotics to treat highly resistant bacterial infections is especially challenging because only a small number of patients contract these infections and meet the requirements to participate in traditional clinical trials.
While research and development are essential, “we cannot just discover and develop our way out of this crisis,” said Helen Boucher, an infectious diseases doctor at Tufts University and a spokeswoman for the Infectious Diseases Society of America. Prevention, the appropriate use of antibiotics and surveillance are all necessary as part of a coordinated approach, she said.
In the United States, antibiotic-resistant infections kill an estimated 23 000 Americans each year, according to the CDC. Global estimates are difficult because there is no uniform way to include antimicrobial resistance in causes of death. But experts say that drug-resistant infections, especially those caused by the WHO’s highest-priority pathogens, double or triple the risk of death. “We are talking about millions of people affected,” Tacconelli said.
Tuberculosis, whose resistance has been growing in recent years, was not included in the list because it is targeted by other dedicated programs, WHO said.
– Priority 1: Critical
1. _Acinetobacter baumannii_, carbapenem-resistant
2. _Pseudomonas aeruginosa_, carbapenem-resistant
3. Enterobacteriaceae, carbapenem-resistant, ESBL [extended-spectrum beta-lactamases]-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. _Salmonella_ spp, 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
[Byline: Lena H Sun]
 Date: Tue 28 Feb 2017 5:59 PM ET
Source: NBC News [edited]
Drug-resistant germs that caused horrible wound infections among soldiers in the Viet Nam War, and bloodstream infections among military patients in Iraq and Afghanistan, top a new list of superbug enemies put out by the World Health Organization [Mon 27 Feb 2017]. It’s the 1st-ever priority list written up by WHO, which wants to push drug companies and governments to put money and effort into developing new and better antibiotics.
“This is truly urgent,” WHO’s Dr Marie-Paule Kieny told a news conference. “These bacteria are responsible for severe infections and high mortality rates mostly in hospitalized patients, transplant recipients, those receiving chemotherapy or patients in intensive care units.”
At the top of the list are carbapenem-resistant _Acinetobacter baumannii_ and 2 other bacteria that resist the effects of carbapenem antibiotics — the big guns in the medical arsenal. They are not common among healthy people, but are extremely resistant to drugs and lethal to infected patients. The list also includes carbapenem-resistant Enterobacteriaceae or CRE — the germs that former Centers for Disease Control and Prevention Director Dr Thomas Frieden called “nightmare bacteria.”
“Certainly _Acinetobacter_ are something that we have seen in our returning military service people,” said Dr Helen Boucher of the Infectious Diseases Society of America. “We see it in hospitals here, too,” she said. While the bacteria aren’t a big threat to most healthy people, they can infect children and young adults with cystic fibrosis, people undergoing chemotherapy, and organ transplant patients, Boucher added.
Germs from CREs to MRSA — methicillin-resistant _Staphylococcus aureus_ — are becoming more common around the world. The CDC estimates that 23 000 Americans die every year from drug-resistant infections. “Antibiotic resistance is growing, and we are fast running out of treatment options,” Kieny said. “If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time.”
The germs develop resistance through a variety of tricks. They can swap cassettes of DNA, even to different species in a process that allows even faster spread of antibiotic resistance. Among the most notorious are extended-spectrum beta-lactamases (ESBL) enzymes that allow bacteria to scoff at penicillins, cephalosporins and other commonly used antibiotics. Others carry a mutation called NDM-1 — named after New Delhi — which helps them resist a variety of drugs.
Boucher said IDSA and other groups will work to keep the issue at the top of the agenda for the new Trump administration. Former president Barack Obama had made it a priority during his administration. The Food and Drug Administration has been working on ways to make it easier and faster for drug companies to develop antibiotics.
“Antibiotic resistance is growing, and we are fast running out of treatment options.” There aren’t any groundbreaking new antibiotics in development, and companies have little incentive to look for them. One way to make these drugs work better is to use them less, and to target them to specific infections. “The pipeline is practically dry,” Kieny said.
One possible carrot would be tax credits for companies that develop drugs for the most threatening infections, Boucher said. Kieny called for governments to pony up bonuses for companies to help make it more appealing to develop drugs that would have limited use. “We are now looking at … public-private partnerships as ways to develop these drugs,” Boucher added.
Dr Rupa Kanapathipillai of Doctors Without Borders, also known as Médecins Sans Frontières or MSF, said drug-resistant infections are a big problem in developing countries and especially in areas of conflict. “We see — with alarming regularity — the critical-listed bacterial infections in people we treat in the field, including babies and children, burn victims and conflict and trauma injuries,” Kanapathipillai said in a statement. “It’s getting harder to treat people for drug-resistant infections in the resource-limited settings in which we work. With the priority pathogen list, we need to urgently see new antibiotics developed that are affordable, appropriate and accessible to fill a depleted drug pipeline.”
Not on the list is tuberculosis, which kills 1.8 million people a year. Drug-resistant TB is a growing problem but it has its own dedicated program, Kieny said.
[Byline: Maggie Fox]
[The WHO news release is available at http://www.who.int/mediacentre/news/releases/2017/bacteria-antibiotics-needed/en/. – Mod.ML]
Antibiotic resistance (01): China: colistin, MCR-1 clin. Enterobacteriaceae isolates 20170129.4799871
Carbapenem-resistant Enterobacteriaceae – Ireland: (LK) nosocomial, fatal, 2009-2015 20161124.4652418
Antibiotic resistance (04): India, China, environmental pollution 20161020.4574059
Antibiotic resistance (03): India (TG) environmental pollution 20161010.4548738
Antibiotic -resistant Enterobacteriaceae – USA: (CA) reportable 20161008.4545844
Gonococcal disease – USA (05): (HI) ceftriaxone plus azithromycin resistance 20160924.4513277
Antibiotic resistance (02): UN General Assembly 2016, WHO Global Action Plan 20160923.4511617
Antibiotic resistance: International Journal of Infectious Diseases, editorial 20160918.4497194
Antibiotic resistance – USA (06): ESBL, FQ, E. coli, UTI 20160918.4496481
Antibiotic resistance – France: non-MCR-1, colistin/carbapenem, 2014 20160916.4492825
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Antibiotic resistance – Europe, Canada: colistin, MCR-1, E. coli, bovine, human 20160808.4400601
Antibiotic resistance – Germany: colistin, MCR-1, E. coli, poultry, 2010 – 2015 20160728.4374873
Gonococcal disease – USA (03): increasing azithromycin resistance, 2014 20160716.4349791
Antibiotic resistance – Belgium: colistin, MCR-2, plasmid, E. coli, pigs, calves 20160709.4335297
Antibiotic resistance – Portugal: colistin, MCR-1, Salmonella, Cu tolerance 20160703.4323241
Antibiotic resistance – USA (03): (NY) colistin, MCR-1, E. coli, human 20160630.4317770
Antibiotic resistance – multicountry: colistin, MCR-1, E. coli, gull 20160630.4313655
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Antibiotic resistance – USA (02): colistin, MCR-1, E. coli, pig 20160616.4290293
Antibiotic resistance – USA: colistin, MCR-1, E. coli, human, pig 20160528.4251552
Antibiotic resistance – Denmark: AR genes, archived soil, 1923-2010 20160224.4047676
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Antibiotic resistance – Canada: colistin, MCR-1, E. coli, grd. beef, human, 2010 20160106.3915891
Gonococcal disease – UK: (England) azithromycin monotherapy resistance, RFI 20160103.3907866
Feb. 1, 2016: Last-Ditch Antibiotic Resistance: What is the Role of Food?
Jan. 7, 2016: Last-Ditch Resistance: More Countries, More Dire Results
Jan. 6, 2016: Last-Ditch Drug Resistance: China and Europe Respond
Dec. 18, 2015: Resistance to a Last-Ditch Antibiotic: Invisible Spread
Dec. 15, 2015: More Countries Are Seeing a Last-Ditch Antibiotic Failing
Dec. 3, 2015: Apocalypse Pig Redux: Last-Resort Resistance in Europe
Nov. 21, 2015: Apocalyse Pig: The Last Antibiotic Begins to Fail
Source: National Geographic