A recent report from the Centers for Disease Control and Prevention (CDC), published in the Annals of Internal Medicine, has identified a significant increase in infections caused by NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE) in the United States. The bacteria are resistant to some of the most powerful antibiotics available, making them difficult to treat and potentially deadly.
According to CDC data, between 2019 and 2023, NDM-CRE infections rose by more than 460% across the country. These infections can lead to pneumonia, bloodstream infections, urinary tract infections, and wound infections. Many clinical laboratories lack the necessary testing capacity to detect these bacteria quickly.
“This sharp rise in NDM-CRE means we face a growing threat that limits our ability to treat some of the most serious bacterial infections,” said Danielle Rankin, an epidemiologist in CDC’s Division of Healthcare Quality Promotion. “Selecting the right treatment has never been more complicated, so it is vitally important that healthcare providers have access to testing to help them select the proper targeted therapies.”
NDM-CRE refers to bacteria that produce New Delhi metallo-β-lactamase (NDM), an enzyme that makes them resistant to nearly all antibiotics. Because these types of bacteria have historically been rare in the U.S., healthcare providers may not immediately suspect them when treating patients with CRE infections. This can result in ineffective treatments.
The CDC report notes that NDM-CRE poses a serious risk due to high rates of morbidity and mortality associated with infection. Without appropriate infection prevention and control measures, these bacteria can spread rapidly within healthcare settings and into communities.
Factors contributing to this surge include gaps in infection control practices such as hand hygiene and use of protective equipment during patient care. Limited testing capabilities also play a role; many hospitals do not have tools for rapid detection, which can delay treatment and allow further transmission.
The CDC recommends that healthcare providers stay informed about local trends related to CRE, test promptly for specific resistance mechanisms when CRE is detected, carefully select antibiotics based on those results, and strengthen infection prevention practices according to established guidelines. The agency also encourages collaboration with state and local programs focused on healthcare-associated infections and antimicrobial resistance.
For additional information about NDM-CRE or ways to prevent its spread, resources are available at https://www.cdc.gov/cre/about/index.html and https://www.cdc.gov/antimicrobial-resistance-laboratory-networks/php/about/domestic.html.
