Antimicrobial resistance has been steadily increasing over the years and is nearing crisis levels. Although much resistance is due to patients in nations like the United States demanding antibiotics for diseases like the cold that are often caused by viruses, antimicrobial resistance is also on the rise in developing nations. The priority of these drug-resistant superbugs was determined by a number of criteria including mortality, burden, the prevalence of resistance, the trend of resistance, transmissibility, treatability and preventability.

Because there are already concerted efforts to combat drug-resistant tuberculosis and malaria, they are not part of the dirty dozen list of drug-resistant superbugs. Here are a few of the priority pathogens that affect the developing world:

1. 1. Campylobacter – Campylobacter is the most common cause of bacterial gastroenteritis worldwide. In developing countries, infections are seasonal. One of the major risk factors is exposure to contaminated drinking water.
   2. Salmonella – Salmonella is one of four major causes of diarrheal disease. Although most cases are mild, some can be life-threatening, especially in young children. Treatment with electrolyte replacement is usually sufficient, but for more vulnerable populations antibiotics may be warranted. With the rise in drug resistance, guidelines need to be reviewed regularly to ensure the most effective treatment remains first-line.
   3. Gonorrhea – Gonorrhea is a sexually transmitted disease that causes vaginal pain or discharge in women. It is often asymptomatic in men but can cause a burning sensation on urination and testicular pain. Left untreated, it can lead to serious complications like infertility and sterility. In rare cases, the infection can become life-threatening if it invades the bloodstream or joints. With the rise of antimicrobial resistance, serious cases of gonorrhea could become more common.
   4. Shigella – Shigella is the most common cause of dysentery or bloody diarrhea. Bloody diarrhea is often the result of hemolytic uremic syndrome (HUS), one of the complications associated with shigella. HUS develops when the bacteria produces a red blood cell-destroying toxin. Like gonorrhea, a Shigella infection can become especially problematic if it spreads to the joints or bloodstream.

Also featured on WHO’s list were: acinetobacter, pseudomonas, enterobacteria, Enterococcus faecium, H. pylori, Staphylococcus aureus, streptococcus pneumonia and Haemophilus influenza. Without swift and effective intervention, the dirty dozen drug-resistant superbugs could devastate communities all over the world. In the words of the WHO director-general, “The emergence and spread of drug-resistant pathogens have accelerated. The trends are clear and ominous. No action today means no cure tomorrow.”

– Rebecca Yu

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