Evelina Tacconelli1, Elena Carrara2, Alessia Savoldi3, Stephan Harbarth4, Marc Mendelson5, Dominique L Monnet6, Céline Pulcini7, Gunnar Kahlmeter8, Jan Kluytmans9, Yehuda Carmeli10, Marc Ouellette11, Kevin Outterson12, Jean Patel13, Marco Cavaleri14, Edward M Cox15, Chris R Houchens16, M Lindsay Grayson17, Paul Hansen18, Nalini Singh19, Ursula Theuretzbacher20, Nicola Magrini21. 1. German Centre for Infection Research, Tübingen University Hospital, Tübingen, Germany; Verona University Hospital, Verona, Italy. Electronic address: evelina.tacconelli@med.uni-tuebingen.de. 2. German Centre for Infection Research, Tübingen University Hospital, Tübingen, Germany; Verona University Hospital, Verona, Italy. 3. German Centre for Infection Research, Tübingen University Hospital, Tübingen, Germany. 4. World Health Organization Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 5. Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. 6. European Centre for Disease Prevention and Control, Stockholm, Sweden. 7. EA 4360 APEMAC, Nancy University Hospital, Lorraine University, Nancy, France. 8. Central Hospital, Växjö, Sweden. 9. University Medical Center, Utrecht, Netherlands; Amphia Hospital, Breda, Netherlands. 10. Laboratory for Microbiology and Infection Control, Tel Aviv University, Tel Aviv, Israel. 11. Laval University and Canadian Institutes for Health Research, Québec, QC, Canada. 12. Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator CARB-X, Boston University, Boston, MA, USA. 13. Centers for Disease Control and Prevention, Atlanta, GA, USA. 14. European Medicines Agency, London, UK. 15. US Food and Drug Administration, Washington, DC, USA. 16. Antibacterials Program Biomedical Advanced Research and Development Authority, Washington, DC, USA. 17. Austin Health, University of Melbourne, Melbourne, VIC, Australia. 18. Department of Infectious Diseases and Microbiology, University of Otago, Dunedin, New Zealand. 19. Children's National Health System, George Washington University, Washington, DC, USA. 20. Center for Anti-infective Agents, Vienna, Austria. 21. Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland.
Abstract
BACKGROUND: The spread of antibiotic-resistant bacteria poses a substantial threat to morbidity and mortality worldwide. Due to its large public health and societal implications, multidrug-resistant tuberculosis has been long regarded by WHO as a global priority for investment in new drugs. In 2016, WHO was requested by member states to create a priority list of other antibiotic-resistant bacteria to support research and development of effective drugs. METHODS: We used a multicriteria decision analysis method to prioritise antibiotic-resistant bacteria; this method involved the identification of relevant criteria to assess priority against which each antibiotic-resistant bacterium was rated. The final priority ranking of the antibiotic-resistant bacteria was established after a preference-based survey was used to obtain expert weighting of criteria. FINDINGS: We selected 20 bacterial species with 25 patterns of acquired resistance and ten criteria to assess priority: mortality, health-care burden, community burden, prevalence of resistance, 10-year trend of resistance, transmissibility, preventability in the community setting, preventability in the health-care setting, treatability, and pipeline. We stratified the priority list into three tiers (critical, high, and medium priority), using the 33rd percentile of the bacterium's total scores as the cutoff. Critical-priority bacteria included carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, and carbapenem-resistant and third-generation cephalosporin-resistant Enterobacteriaceae. The highest ranked Gram-positive bacteria (high priority) were vancomycin-resistant Enterococcus faecium and meticillin-resistant Staphylococcus aureus. Of the bacteria typically responsible for community-acquired infections, clarithromycin-resistant Helicobacter pylori, and fluoroquinolone-resistant Campylobacter spp, Neisseria gonorrhoeae, and Salmonella typhi were included in the high-priority tier. INTERPRETATION: Future development strategies should focus on antibiotics that are active against multidrug-resistant tuberculosis and Gram-negative bacteria. The global strategy should include antibiotic-resistant bacteria responsible for community-acquired infections such as Salmonella spp, Campylobacter spp, N gonorrhoeae, and H pylori. FUNDING: World Health Organization.
BACKGROUND: The spread of antibiotic-resistant bacteria poses a substantial threat to morbidity and mortality worldwide. Due to its large public health and societal implications, multidrug-resistant tuberculosis has been long regarded by WHO as a global priority for investment in new drugs. In 2016, WHO was requested by member states to create a priority list of other antibiotic-resistant bacteria to support research and development of effective drugs. METHODS: We used a multicriteria decision analysis method to prioritise antibiotic-resistant bacteria; this method involved the identification of relevant criteria to assess priority against which each antibiotic-resistant bacterium was rated. The final priority ranking of the antibiotic-resistant bacteria was established after a preference-based survey was used to obtain expert weighting of criteria. FINDINGS: We selected 20 bacterial species with 25 patterns of acquired resistance and ten criteria to assess priority: mortality, health-care burden, community burden, prevalence of resistance, 10-year trend of resistance, transmissibility, preventability in the community setting, preventability in the health-care setting, treatability, and pipeline. We stratified the priority list into three tiers (critical, high, and medium priority), using the 33rd percentile of the bacterium's total scores as the cutoff. Critical-priority bacteria included carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, and carbapenem-resistant and third-generation cephalosporin-resistant Enterobacteriaceae. The highest ranked Gram-positive bacteria (high priority) were vancomycin-resistant Enterococcus faecium and meticillin-resistant Staphylococcus aureus. Of the bacteria typically responsible for community-acquired infections, clarithromycin-resistant Helicobacter pylori, and fluoroquinolone-resistant Campylobacter spp, Neisseria gonorrhoeae, and Salmonella typhi were included in the high-priority tier. INTERPRETATION: Future development strategies should focus on antibiotics that are active against multidrug-resistant tuberculosis and Gram-negative bacteria. The global strategy should include antibiotic-resistant bacteria responsible for community-acquired infections such as Salmonella spp, Campylobacter spp, N gonorrhoeae, and H pylori. FUNDING: World Health Organization.
Authors: Madeline R Galac; Erik Snesrud; Francois Lebreton; Jason Stam; Michael Julius; Ana C Ong; Rosslyn Maybank; Anthony R Jones; Yoon I Kwak; Kate Hinkle; Paige E Waterman; Emil P Lesho; Jason W Bennett; Patrick Mc Gann Journal: Antimicrob Agents Chemother Date: 2020-09-21 Impact factor: 5.191
Authors: María Ayelén Carabajal; Christopher R M Asquith; Tuomo Laitinen; Graham J Tizzard; Lucía Yim; Analía Rial; José A Chabalgoity; William J Zuercher; Eleonora García Véscovi Journal: Antimicrob Agents Chemother Date: 2019-12-20 Impact factor: 5.191
Authors: Gisela Di Venanzio; Ki Hwan Moon; Brent S Weber; Juvenal Lopez; Pek Man Ly; Robert F Potter; Gautam Dantas; Mario F Feldman Journal: Proc Natl Acad Sci U S A Date: 2019-01-09 Impact factor: 11.205
Authors: N M Smith; J R Lenhard; K R Boissonneault; C B Landersdorfer; J B Bulitta; P N Holden; A Forrest; R L Nation; J Li; B T Tsuji Journal: Clin Microbiol Infect Date: 2020-02-12 Impact factor: 8.067
Authors: Timothy M Wannier; Akos Nyerges; Helene M Kuchwara; Márton Czikkely; Dávid Balogh; Gabriel T Filsinger; Nathaniel C Borders; Christopher J Gregg; Marc J Lajoie; Xavier Rios; Csaba Pál; George M Church Journal: Proc Natl Acad Sci U S A Date: 2020-05-28 Impact factor: 11.205