Canada's 2025 AMR priority pathogens: Evidence-based ranking and public health implications

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Antimicrobial resistance (AMR) is a significant global health challenge impacting healthcare.
• Canada's initial AMR pathogen list (2015) required updating due to evolving resistance patterns and enhanced surveillance.
• The Canadian Antimicrobial Resistance Surveillance System (CARSS) provides foundational data.

Purpose of the Study:

• To systematically update Canada's AMR pathogen prioritization using national data.
• To identify the most pressing AMR threats to inform surveillance and public health strategies.
• To integrate health equity into the AMR risk assessment framework.

Main Methods:

• A multi-criteria decision analysis (MCDA) evaluated 155 potential AMR pathogens using Canadian data (2017-2022).
• Nine criteria, including health equity, were used for risk-based pathogen ranking.
• Expert consensus informed criterion weighting, with sensitivity analysis ensuring robustness.

Main Results:

• Twenty-nine AMR pathogens were identified as significant risks, categorized into four tiers.
• Tier 1 pathogens (e.g., Carbapenem-resistant Enterobacterales, Candida auris) represent the highest public health risk.
• Prioritization highlights concerns in sexually transmitted infections (STIs) like Drug-resistant Neisseria gonorrhoeae and Drug-resistant Shigella spp.

Conclusions:

• The updated prioritization offers an equity-informed framework for Canadian AMR surveillance and response.
• Identifies high-impact pathogens and critical surveillance areas for targeted public health action.
• Provides a strategic tool to guide research, innovation, and infection prevention efforts.