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.

Original languageEnglish
Pages (from-to)318-327
Number of pages10
JournalThe Lancet Infectious Diseases
Volume18
Issue number3
DOIs
StatePublished - Mar 2018

Funding

FundersFunder number
Adrian John Brink
Agnes Wechsler-Fördös
Allecra Therapeutics
Angelo Pan
Anna Zorzet
BioMerieux SA
Brussels and Deutsches Zentrum für Infektionsforschung
Deepthi Kattula
Fidan O Yilmaz
Francesco Robert Burkert
Gabriel Levy Hara
Giuseppe Cornaglia
Haibo Qiu
Heiman F L Wertheim
Herman Goossens
IMI Brussels
Jaime Labarca
Jasper Littman
Jesús Rodríguez-Baño
Karin Leder
Leonard Leibovici
Manuel Guzman Blanco
Maria Virginia Villegas
Marie-Paule Kieny
Maurizio Sanguinetti
Nguyen Van Kinh
Nordiah Awang Jalil
Oliver James Dyar (Sweden), Alexander W Friedrich
Rempex Pharmaceuticals
Seif S Al-Abri
Sharmila Sengupta (India), Mike Sharland (UK), Massinissa Si-Mehand
Silvio Vega
Souha S Kanj
Surbhi Malothra-Kumar
Thomas Gottlieb
Vikas Manchanda
Waleria Hryniewicz
Pfizer
AstraZeneca
GlaxoSmithKline
Roche
World Health Organization
Merck Sharp and Dohme
Wellcome Trust
Biomedical Advanced Research and Development Authority
Shionogi
Innovative Medicines Initiative

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