As an example, Canada recently launched their own “pathogen prioritization list,” which lists dangerous organisms in order of threat. The list groups pathogens into four levels (I-IV), with Level I designating the highest priority and Level IV the lowest. It’s based primarily on data collected between 2017 and 2022. This new effort will help improve public health approaches and infection control measures, and strengthen antibiotic stewardship throughout the country.
Dr. Kanchana Amaratunga is the medical advisor to Canada’s national antimicrobial resistance task force. She stressed that the list is an important tool in addressing the global threat of evolving infectious diseases. Beyond the ranking system’s top 10, it examines hundreds of pathogens in-depth. Considerations include treatability, transmission rates, case fatality ratios and impacts on marginalized populations.
Dr. Gerry Wright, a professor of biochemistry and biomedical sciences at McMaster University, stated that the list “reflects the current reality in Canada.” He pointed out that some organisms on the list are particularly alarming. Their treatment resistance and community prevalence make them a huge public safety issue.
Key Pathogens on the List
Also on the high-priority list is Pseudomonas, a famously stubborn organism that Dr. Wright depicted as “armed to the teeth.” This emerging pathogen, which is an environmental fungus, presents an extraordinary risk especially to immunocompromised individuals. From an accident to stroke, death rates for these people can soar up to 60 percent.
Pseudomonas are notoriously tough to kill, as it can escape the effects of nearly every antibiotic, making it a clinical heavyweight champion. She also highlighted its link to life-threatening infections including pneumonia, cementing its sinister reputation.
The fungus Candida auris is an emerging and deadly threat. Still, with its daunting kill rate of up to 60 percent, that is no small feat. The list calls out Carbapenem-resistant Enterobacterales, which includes notorious bacteria like E. coli and Salmonella. These pathogens are responsible for life-threatening infections of the urinary tract, abdomen, and bloodstream.
“It’s a vicious organism, really intrinsically drug-resistant. It doesn’t seem to care too much about any antibiotics,” – Dr. Gerry Wright
Rising Infection Rates
This backdrop is only made worse by the frightening trends we see as cases continue to rise across the country. As of 2022, the national gonorrhea rate has increased 123% since 2009. It hit three times the rate from three decades ago, a historic high in 30 years. Dr. Amaratunga cautioned that untreated gonorrhea infections can result in serious complications, such as pelvic inflammatory disease and infertility.
Invasive pneumococcal disease surged due to the diffusion of vaccine-preventable strains. Close to 68 percent of reported cases were vaccine-preventable. This shocking statistic underlines the importance of increasing and improving vaccination programs, including COVID vaccines. To bring these pathogens under control, we need to adopt effective public health interventions.
“If you can’t treat gonorrhea, it can lead to pelvic inflammatory disease or infertility in the future,” – Dr. Kanchana Amaratunga
Dr. Wright made an alarming observation. For some of our most powerful antibiotics, including carbapenems, resistance has increased explosively over the last 20 years. He described carbapenems as “the last station on the penicillin highway,” underscoring their significance in treating severe infections.
“If you look at your IV bag and you see the word carbapenem, you know you’re in trouble,” – Dr. Gerry Wright
Future Directions and Recommendations
The newly created pathogen watchlist would receive updates every three to five years. This tactic is a monumental switch from the last 10-year span. Both Dr. Wright and Dr. Amaratunga advocate for this more frequent assessment to ensure that public health responses can adapt promptly to emerging threats.
Prevention strategies are prevention’s greatest weapon in tackling the global rise of antimicrobial resistance. They all agree that we need to use antibiotics more strategically. Their advocacy extends to better surveillance systems, immediate detection protocols, and robust vaccination campaigns to protect those most at risk.
“And no matter what drug you bring into the country, resistance is inevitable,” – Dr. Kanchana Amaratunga
