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WHO updated the list of priority bacterial pathogens for combating antibiotic resistance
Last reviewed: 02.07.2025
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The World Health Organization (WHO) has released an updated list of priority bacterial pathogens (BPPL) for 2024, including 15 families of antibiotic-resistant bacteria. These bacteria are grouped into critical, high, and intermediate categories for priority attention. The list provides guidance on the development of new, needed treatments to stop the spread of antimicrobial resistance (AMR).
AMR occurs when bacteria, viruses, fungi and parasites no longer respond to drugs, making people sicker and increasing the risk of spreading disease, morbidity and mortality. The main causes of AMR are the misuse and overuse of antimicrobials. The updated BPPL includes new data and expert opinions to guide research and development (R&D) of new antibiotics and to stimulate international coordination to promote innovation.
“Mapping the global burden of drug-resistant bacteria and assessing their public health impact is key to guiding investments and tackling the antibiotic and access crisis,” says Dr Yukiko Nakagani, WHO Deputy Director-General a.i. for Antimicrobial Resistance.
Critical Priority Pathogens
Critical priority pathogens such as Gram-negative bacteria resistant to last-line antibiotics and rifampicin-resistant Mycobacterium tuberculosis pose serious global threats due to their high burden and ability to resist treatment and spread resistance to other bacteria. Gram-negative bacteria have built-in mechanisms to find new ways to resist treatment and can transfer genetic material to other bacteria, allowing them to become drug-resistant.
High Priority Pathogens
High priority pathogens such as Salmonella and Shigella have a particularly high burden in low- and middle-income countries, as do Pseudomonas aeruginosa and Staphylococcus aureus, which pose significant problems in health care settings.
Other high priority pathogens, such as antibiotic-resistant Neisseria gonorrhoeae and Enterococcus faecium, pose unique public health challenges, including persistent infections and resistance to multiple antibiotics, requiring targeted public health research and interventions.
Medium priority pathogens
Medium priority pathogens include Streptococcus groups A and B (both new to the 2024 list), Streptococcus pneumoniae, and Haemophilus influenzae, which represent a high disease burden. These pathogens require increased attention, particularly among vulnerable populations, including children and the elderly, especially in resource-limited settings.
“Antimicrobial resistance threatens our ability to effectively treat high-burden infections such as tuberculosis, which lead to severe illness and increased mortality,” said Dr Jérôme Salomon, WHO Assistant Director-General for Universal Health Coverage and Communicable and Noncommunicable Diseases.
Changes in the 2017 and 2024 lists
BPPL 2024 includes the removal of five pathogen-antibiotic combinations from the 2017 list and the addition of four new combinations. The inclusion of Enterobacterales resistant to third-generation cephalosporins as a separate item in the critical priority category highlights their burden and the need for targeted interventions, particularly in low- and middle-income countries.
The move of carbapenem-resistant Pseudomonas aeruginosa (CRPA) from critical to high category in BPPL 2024 reflects recent reports of declining global resistance. Despite this change, investment in R&D and other prevention and control strategies for CRPA remains important given its significant burden in some regions.
WHO BPPL 2024 includes the following bacteria:
Critical Priority:
- Acinetobacter baumannii, carbapenem-resistant;
- Enterobacterales resistant to third-generation cephalosporins;
- Carbapenem-resistant Enterobacterales;
- Mycobacterium tuberculosis resistant to rifampicin (included after independent analysis using an adapted multicriteria decision matrix).
High priority:
- Fluoroquinolone-resistant Salmonella Typhi;
- Shigella spp. resistant to fluoroquinolones;
- Vancomycin-resistant Enterococcus faecium;
- Pseudomonas aeruginosa, carbapenem-resistant;
- Non-typhoidal Salmonella, fluoroquinolone-resistant;
- Neisseria gonorrhoeae resistant to third-generation cephalosporins and/or fluoroquinolones;
- Methicillin-resistant Staphylococcus aureus.
Medium priority:
- Macrolide-resistant Streptococcus group A;
- Streptococcus pneumoniae, macrolide-resistant;
- Haemophilus influenzae, ampicillin-resistant;
- Penicillin-resistant group B Streptococcus.
The changes since 2017 reflect the dynamic nature of AMR, which requires tailored interventions. Using the BPPL as a global tool, taking into account regional contexts, can account for variations in pathogen distribution and AMR burden. For example, antibiotic-resistant Mycoplasma genitalium, which is not listed, is a growing problem in some parts of the world.