Evolving priorities in the WHO Bacterial Priority Pathogens List

The 2024 World Health Organization (WHO) Bacterial Priority Pathogens List (BPPL) updates the 2017 framework by expanding to 24 pathogens across 15 bacterial families, addressing the growing antimicrobial resistance (AMR) crisis, which was estimated to have caused 1.27 million deaths in 2019. The revised list introduces four new pathogen-antibiotic combinations—rifampicin-resistant Mycobacterium tuberculosis, macrolide-resistant Group A Streptococci, macrolide-resistant Streptococcus pneumoniae, and penicillin-resistant Group B Streptococci—while removing five, including clarithromycin-resistant Helicobacter pylori, reflecting evolving resistance patterns, regional disparities, and therapeutic advancements. Notably, third-generation cephalosporin-resistant Enterobacterales is now a standalone critical-priority pathogen due to its high burden in low- and middle-income countries. This review examines these updates, driven by complex resistance mechanisms, surveillance gaps, and the impact of coronavirus disease 2019 (COVID-19)-related antibiotic misuse. It highlights trends such as the dominance of Gram-negative bacteria, rising rates of community-acquired infections, and the urgent need for innovative therapies, including phage therapy, phenazine-based antimicrobials, and metal-based strategies. Enhanced global surveillance, equitable access to treatments, and collaborative efforts are critical to combating AMR effectively.