The Public Health Agency of Canada (PHAC) has published a new list of the drug-resistant bacteria that pose the greatest health threat to Canadians.
The 2025 Antimicrobial Resistance (AMR) Priority Pathogen list, published yesterday in PLOS One, was developed by AMR experts from PHAC and the Canadian AMR Surveillance System (CARSS) using nationally representative surveillance data from 2017 through 2022 and nine prioritization criteria that reflect the country's public health priorities. Prioritization criteria included incidence, trend (change in the proportion of resistant cases), mode of transmission, morbidity, mortality, treatability, and equity, which was newly added to the list to reflect level of exposure to resistant bacteria and barriers to treatment.
Of the 68 pathogens initially identified as AMR threats, 29 were selected for full evaluation. The Tier 1 group, defined as high-priority pathogens based on their scores, includes carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), carbapenem-resistant Acinetobacter (CRA), drug-resistant gonorrhea, Candida auris, and extended-spectrum beta-lactamase–producing Enterobacterales.
"High rankings for CRE, CRPA, and CRA were primarily driven by treatability challenges, with limited or absent treatment options, including barriers to access, and the more severe disease outcomes associated with these infections," the authors wrote.
The medium-priority group (Tier 2) includes methicillin-resistant Staphylococcus aureus, drug-resistant Streptococcus pneumoniae, drug-resistant Shigella, and vancomycin-resistant Enterococcus. Pathogens in the Tier 3 group (medium to low priority) include Clostridioides difficile, drug-resistant Salmonella, and multidrug-resistant tuberculosis, and Tier 4 (low priority) includes drug-resistant Campylobacter and drug-resistant Helicobacter pylori.
A 'more inclusive' assessment of AMR threats
The authors say a key finding is that 45% of the assessed AMR pathogens disproportionately affect populations experiencing "social or economic marginalization and structural barriers to health," such as sex workers, men who have sex with men, the homeless, and refugees or migrants from conflict or disaster-affected regions.
"By explicitly integrating health equity as a prioritization criterion for the first time, this exercise allowed for a more inclusive and contextually grounded assessment of AMR threats in Canada," they wrote. "Rather than relying solely on traditional metrics such as incidence or mortality, this approach recognizes that vulnerability to AMR is shaped by broader social determinants of health."