{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T21:51:14Z","timestamp":1791323474288,"version":"4.3.1"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Antimicrobial resistance (AMR) is a growing global health threat that undermines the effectiveness of treatments and the sustainability of health systems. In 2015, Canada published its first AMR pathogen prioritization list, which laid the foundation for the Canadian Antimicrobial Resistance Surveillance System (CARSS). Since then, evolving resistance patterns, newly emerging pathogens, and enhanced surveillance capacity have prompted a comprehensive update to identify the most pressing AMR threats in the Canadian context.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To undertake a systematic and reproducible prioritization process, leveraging nationally representative Canadian data, and to identify the most pressing AMR threats. This risk prioritization aims to inform surveillance strategies, which then lends itself to infection prevention and control measures, stewardship initiatives, and research and innovation directions.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A total of 155 pathogens identified as potential threats to Canadians were assessed to determine whether AMR posed a significant concern. Pathogens selected for further evaluation underwent a multi-criteria decision analysis (MCDA) using Canadian data from 2017 to 2022. Nine prioritization criteria, including health equity introduced for the first time, were used to evaluate and rank pathogens based on their risk to public health. Weights were assigned to each criterion, informed by expert consensus, to reflect their relative importance. A sensitivity analysis was conducted to test the robustness of the rankings under different weighting scenarios, ensuring the reliability of the top-ranked AMR pathogens in Canada.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Twenty-nine AMR pathogens were ascertained as significant risks to Canadians and categorized into four tiers based on incidence, treatability, transmission, and health equity. Tier 1 pathogens, including Carbapenem-resistant\n \n Enterobacterales, Candida auris<\/jats:italic>\n <\/jats:italic>\n , Drug-resistant\n \n Neisseria gonorrhoeae<\/jats:italic>\n <\/jats:italic>\n , and Drug-resistant\n \n Shigella spp<\/jats:italic>\n <\/jats:italic>\n ., pose the highest risk due to limited treatment options, potentially higher morbidity and mortality, and disproportionate impacts on marginalized populations. The prioritization of\n \n N. gonorrhea<\/jats:italic>\n <\/jats:italic>\n and Drug-resistant\n \n Shigella spp.<\/jats:italic>\n <\/jats:italic>\n along with the inclusion of\n \n Mycoplasma genitalium<\/jats:italic>\n <\/jats:italic>\n in Tier 2 highlight growing concerns in sexually transmitted infections (STIs). These findings underscore the need for continued enhanced surveillance, targeted interventions, and a health equity lens in AMR prioritization.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This updated prioritization provides a robust, equity-informed framework to guide AMR surveillance and responses in Canada. It identifies high-impact pathogens and surveillance areas, offering a strategic tool to support public health action and research.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0330128","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T17:21:33Z","timestamp":1758129693000},"page":"e0330128","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Canada\u2019s 2025 AMR priority pathogens: Evidence-based ranking and public health implications"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0929-0422","authenticated-orcid":true,"given":"Kahina","family":"Abdesselam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5252-1256","authenticated-orcid":true,"given":"Raymond-Jonas","family":"Ngendabanka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia K.","family":"Muchaal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanchana","family":"Amaratunga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aanchal","family":"Mishra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi","family":"Narkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna-Louise","family":"Crago","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Lary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"pone.0330128.ref001","volume-title":"No time to wait: securing the future from drug-resistant infections","author":"World Health Organization B.","year":"2019"},{"key":"pone.0330128.ref002","unstructured":"World Health Organization B. Ten threats to global health in 2019 who.int: WHO; 2019. Available from: https:\/\/www.who.int\/news-room\/spotlight\/ten-threats-to-global-health-in-2019"},{"key":"pone.0330128.ref003","volume-title":"When antibiotics fail: the expert panel on the potential socio-economic impacts of antimicrobial resistance in Canada","author":"BB Finlay","year":"2019"},{"issue":"4","key":"pone.0330128.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0125155","article-title":"An assessment of antimicrobial resistant disease threats in Canada","volume":"10","author":"MJ Garner","year":"2015","journal-title":"PLoS One"},{"key":"pone.0330128.ref005","unstructured":"Canada PHAo. Canadian Antimicrobial Resistance Surveillance System (CARSS) Report 2022. Canada.ca: 2022 2022-11-28. Report No."},{"key":"pone.0330128.ref006","volume-title":"Canadian Antimicrobial Resistance Surveillance System (CARSS)","author":"Canada PHAo.","year":"2024"},{"key":"pone.0330128.ref007","article-title":"Canadian Antimicrobial Resistance Surveillance System Report 2016","author":"Canada PHAo.","journal-title":"2016 2016-09-12."},{"key":"pone.0330128.ref008","unstructured":"Canada PHAo. Dashboard on the Enhanced Surveillance of Antimicrobial-resistant Gonorrhea system (ESAG): 2018 to 2023 2025. Available from: https:\/\/infobase-dev.com\/ESAG\/index.html"},{"key":"pone.0330128.ref009","doi-asserted-by":"crossref","first-page":"522","DOI":"10.14745\/ccdr.v48i1112a05","article-title":"Overview of Canada\u2019s Antimicrobial Resistance Network (AMRNet): A data-driven One Health approach to antimicrobial resistance surveillance","volume":"48","author":"W Rudnick","year":"2022","journal-title":"Can Commun Dis Rep"},{"issue":"5","key":"pone.0330128.ref010","doi-asserted-by":"crossref","first-page":"235","DOI":"10.14745\/ccdr.v49i05a09","article-title":"Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2017\u20132021","volume":"49","author":"P Canadian Nosocomial Infection Surveillance","year":"2023","journal-title":"Canada Communicable Disease Report"},{"key":"pone.0330128.ref011","unstructured":"Canada PHAo. Candida auris: Infectious substances pathogen safety data sheet 2024. Available from: https:\/\/www.canada.ca\/en\/public-health\/services\/laboratory-biosafety-biosecurity\/pathogen-safety-data-sheets-risk-assessment\/candida-auris.html"},{"key":"pone.0330128.ref012","unstructured":"Ontario PH. Candida auris. 2023."},{"key":"pone.0330128.ref013","unstructured":"CanadaPHAo. Mycoplasma Genitalium guide: Key information and resources 2021. Available from: https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/canadian-guidelines\/mycoplasma-genitalium.html"},{"key":"pone.0330128.ref014","volume-title":"WHO bacterial priority pathogens list, 2024: bacterial pathogens of public health importance, to guide research, development, and strategies to prevent and control antimicrobial resistance","author":"World Health O.","year":"2024"},{"key":"pone.0330128.ref015","unstructured":"World Health O. WHO fungal priority pathogens list to guide research, development and public health action: World Health Organization; 2022."},{"key":"pone.0330128.ref016","unstructured":"Canada PHAo. Tackling Antimicrobial Resistance and Antimicrobial Use: A Pan-Canadian Framework for Action. Canada.ca: 2017 2017-09-05. Report No."},{"key":"pone.0330128.ref017","unstructured":"Canada S. Travel and Tourism Statistics 2025. Available from: https:\/\/www.statcan.gc.ca\/en\/subjects-start\/travel_and_tourism"},{"key":"pone.0330128.ref018","unstructured":"(NAC-STBBI) NACoSTaB-BI. Interim guidance for the treatment of uncomplicated gonococcal infections. 2024."},{"key":"pone.0330128.ref019","unstructured":"Canada PHAo. Canadian guidelines on sexually transmitted infections. 2008."},{"key":"pone.0330128.ref020","unstructured":"Canada PHAo. Chlamydia and LGV guide: Key information and resources. 2025."},{"issue":"9","key":"pone.0330128.ref021","doi-asserted-by":"crossref","first-page":"407","DOI":"10.14745\/ccdr.v48i09a05","article-title":"Invasive group A streptococcal disease surveillance in Canada, 2020","volume":"48","author":"A Golden","year":"2022","journal-title":"CCDR"},{"key":"pone.0330128.ref022","unstructured":"Infections NACoSTaB-B. Gonorrhea guide: Key information and resources Canada.ca 2024. Available from: https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/canadian-guidelines\/gonorrhea.html"},{"issue":"11","key":"pone.0330128.ref023","doi-asserted-by":"crossref","first-page":"2815","DOI":"10.1093\/jac\/dkab269","article-title":"ESBL-positive Escherichia coli and Klebsiella pneumoniae isolates from across Canada: CANWARD surveillance study, 2007\u201318","volume":"76","author":"JA Karlowsky","year":"2021","journal-title":"Journal of Antimicrobial Chemotherapy"},{"issue":"2","key":"pone.0330128.ref024","doi-asserted-by":"crossref","first-page":"71","DOI":"10.3138\/jammi.2018.02.13","article-title":"Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection","volume":"3","author":"VG Loo","year":"2018","journal-title":"Journal of the Association of Medical Microbiology and Infectious Disease Canada"},{"issue":"9","key":"pone.0330128.ref025","doi-asserted-by":"crossref","first-page":"388","DOI":"10.14745\/ccdr.v49i09a05","article-title":"Antimicrobial susceptibilities of Neisseria gonorrhoeae in Canada, 2021","volume":"49","author":"P Sawatzky","year":"2023","journal-title":"Canada Communicable Disease Report"},{"issue":"8","key":"pone.0330128.ref026","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.3201\/eid2908.230323","article-title":"Multidrug-Resistant Shigella sonnei Bacteremia among Persons Experiencing Homelessness, Vancouver, British Columbia, Canada","volume":"29","author":"A Stefanovic","year":"2023","journal-title":"Emerg Infect Dis"},{"key":"pone.0330128.ref027","first-page":"67","volume-title":"Antibiotic resistance threats in the United States","author":"CDC","year":"2019"},{"key":"pone.0330128.ref028","doi-asserted-by":"crossref","unstructured":"Kajihara T, Yahara K, Kitamura N, Hirabayashi A, Hosaka Y, Sugai M. Distribution, trends, and antimicrobial susceptibility of Bacteroides, Clostridium, Fusobacterium, and Prevotella species causing bacteremia in Japan during 2011\u20132020: a retrospective observational study based on national surveillance data. 2023.","DOI":"10.1093\/ofid\/ofad334"},{"key":"pone.0330128.ref029","volume-title":"Surveillance Report Shigella Antimicrobial Resistance","author":"Ontario PH.","year":"2023"},{"key":"pone.0330128.ref030","volume-title":"Carbapenemaseproducing Organisms. (CPO) Protocol","author":"Services AH.","year":"2025"},{"issue":"3","key":"pone.0330128.ref031","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1155\/2015\/853287","article-title":"Antimicrobial susceptibility of Canadian isolates of Helicobacter pylori in Northeastern Ontario","volume":"26","author":"NF Eng","year":"2015","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"pone.0330128.ref032","volume-title":"Frequently Asked Questions Carbapenemase-Producing Enterobacteriaceae (CPE).","author":"Ontario PH.","year":"2019"},{"key":"pone.0330128.ref033","volume-title":"Provincial Infectious Diseases Advisory Committee. Evidence review and revised recommendations for the control of vancomycin-resistant enterococci in all Ontario health care facilities","author":"Ontario) OAfHPaPPH","year":"2019"},{"issue":"6","key":"pone.0330128.ref034","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1139\/cjm-2022-0208","article-title":"Epidemiology of invasive Haemophilus influenzae disease in northwestern Ontario: comparison of invasive and noninvasive H. influenzae clinical isolates","volume":"69","author":"M Ulanova","year":"2023","journal-title":"Can J Microbiol"},{"issue":"2","key":"pone.0330128.ref035","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1155\/2008\/162493","article-title":"Community-associated methicillin-resistant Staphylococcus aureus: Continuing to evolve","volume":"19","author":"B Johnston","year":"2008","journal-title":"Can J Infect Dis Med Microbiol"},{"issue":"2","key":"pone.0330128.ref036","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1093\/pch\/pxz039","article-title":"Invasive group A streptococcal disease: Management and chemoprophylaxis","volume":"24","author":"DL Moore","year":"2019","journal-title":"Paediatr Child Health"},{"key":"pone.0330128.ref037","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1080\/24745332.2022.2039499","article-title":"Chapter 8: Drug-resistant tuberculosis","volume":"6","author":"SK Brode","year":"2022","journal-title":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine"},{"key":"pone.0330128.ref038","unstructured":"(SHSC) SHSC. Antimicrobial stewardship treatment guidelines 2024. Available from: https:\/\/sunnybrook.ca\/content\/?page=antimicrobial-stewardship"},{"issue":"11","key":"pone.0330128.ref039","doi-asserted-by":"crossref","DOI":"10.1097\/CCM.0000000000005357","article-title":"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021","volume":"49","author":"L Evans","year":"2021","journal-title":"Crit Care Med"},{"key":"pone.0330128.ref040","article-title":"Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections","author":"PD Tamma","year":"2024","journal-title":"Clin Infect Dis"},{"key":"pone.0330128.ref041","first-page":"31","article-title":"Clinical implications and treatment of multiresistant Streptococcus pneumoniae pneumonia","author":"Jr File TM","year":"2006","journal-title":"Clin Microbiol Infect"},{"issue":"8","key":"pone.0330128.ref042","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1001\/jama.2016.0289","article-title":"Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"M Shankar-Hari","year":"2016","journal-title":"JAMA"},{"key":"pone.0330128.ref043","volume-title":"Anti-infective Guidelines for Community-acquired Infection: MUMS Health Clearinghouse","author":"Health M.","year":"2024"},{"issue":"4","key":"pone.0330128.ref044","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciw444","article-title":"Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America","volume":"63","author":"TF Patterson","year":"2016","journal-title":"Clin Infect Dis"},{"key":"pone.0330128.ref045","unstructured":"Zanten SVv. TCMP Article: Management of Helicobacter pylori in 2023: who should be tested, treated, and how: UBC Continuing Professional Development; 2023. Available from: https:\/\/ubccpd.ca\/tcmp-article-management-helicobacter-pylori-2023-who-should-be-tested-treated-and-how"},{"key":"pone.0330128.ref046","unstructured":"CATIE. The emergence of dual drug therapy 2024. Available from: https:\/\/www.catie.ca\/treatmentupdate-229\/the-emergence-of-dual-drug-therapy"},{"key":"pone.0330128.ref047","unstructured":"Team RDC. R: A language and environment for statistical computing. (No Title). 2010."},{"issue":"729","key":"pone.0330128.ref048","doi-asserted-by":"crossref","first-page":"187","DOI":"10.3399\/bjgp23X732537","article-title":"Spotlight on drug-resistant Shigella: raising awareness within general practice","volume":"73","author":"H Charles","year":"2023","journal-title":"Br J Gen Pract"},{"issue":"3","key":"pone.0330128.ref049","article-title":"Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children","volume":"52","author":"C Liu","year":"2011","journal-title":"Clin Infect Dis"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T17:21:45Z","timestamp":1758129705000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330128"}},"subtitle":[],"editor":[{"given":"Mabel Kamweli","family":"Aworh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,17]]},"references-count":49,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0330128","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,17]]}}}