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

Antimicrobial resistance (AMR) continues to threaten health in Canada, prompting an update of the country’s pathogen prioritization list originally developed in 2015. Using Canadian surveillance data from 2017–2022, 155 pathogens were evaluated, with 29 identified as significant AMR risks through a multi-criteria decision analysis (MCDA) incorporating nine criteria, including health equity for the first time.

Pathogens were categorized into four tiers. Tier 1 includes Carbapenem-resistant Enterobacterales, Candida auris, drug-resistant Neisseria gonorrhoeae, and drug-resistant Shigella spp., which present the highest risks due to limited treatment options, severe outcomes, and disproportionate effects on vulnerable populations. Concerns were also noted for sexually transmitted infections, with drug-resistant N. gonorrhoeae, Shigella spp., and Mycoplasma genitalium (Tier 2).

The updated prioritization provides a reliable, equity-informed framework to guide Canadian AMR surveillance, infection control, stewardship, and research, ensuring targeted responses to the most pressing threats.