A concerning surge in a dangerous, drug-resistant bacteria is prompting warnings from public health officials. The Centers for Disease Control and Prevention (CDC) recently reported a dramatic increase in NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE) infections across the United States, raising fears about the future of treating serious bacterial infections. These infections, which include pneumonia, bloodstream infections, urinary tract infections, and wound infections, are proving increasingly challenging to combat with existing antibiotics.
The rise of NDM-CRE is particularly alarming because of its resistance to carbapenems, a class of antibiotics often reserved as a last resort for severe infections. The “NDM” portion of the name refers to New Delhi metallo-β-lactamase, an enzyme that renders the bacteria resistant to nearly all available antibiotics, leaving clinicians with limited treatment options. This growing resistance threatens to reverse decades of progress in fighting bacterial infections and could lead to increased morbidity and mortality.
Between 2019 and 2023, NDM-CRE infections surged by more than 460% in the U.S., according to the CDC report published in the Annals of Internal Medicine. This increase builds upon a troubling trend highlighted in a 2022 CDC special report on the impact of COVID-19 on antimicrobial resistance, which documented approximately 12,700 carbapenem-resistant Enterobacterales (CRE) infections and 1,100 deaths in the U.S. In 2020. The current surge in NDM-CRE specifically threatens to exacerbate those numbers.
“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 aid them select the proper targeted therapies.”
Understanding NDM-CRE and the Threat of Antibiotic Resistance
Carbapenem-resistant Enterobacterales (CRE) are a family of bacteria that have developed resistance to carbapenems, powerful antibiotics frequently used to treat infections caused by other, more common bacteria. NDM-CRE represents a particularly concerning subset of CRE due to the presence of the NDM enzyme, which confers resistance to almost all known antibiotics. This leaves very few, and often toxic, treatment options available to clinicians.
The spread of antibiotic resistance is a complex issue driven by several factors, including the overuse and misuse of antibiotics in both human medicine and agriculture. When antibiotics are used unnecessarily, they can kill off susceptible bacteria, leaving behind those that are resistant. These resistant bacteria can then multiply and spread, leading to infections that are harder to treat. The COVID-19 pandemic also likely contributed to the rise in CRE infections, as hospitalizations and antibiotic use increased during the pandemic, creating opportunities for resistant bacteria to spread.
Why Detection and Prevention are Critical
One of the major challenges in combating NDM-CRE is its detection. Many clinical laboratories currently lack the necessary testing capacity to quickly and accurately identify the presence of the NDM enzyme. This can lead to delays in diagnosis and treatment, allowing the infection to worsen and spread. Delayed identification also hinders infection control efforts, increasing the risk of transmission within healthcare facilities.
The CDC emphasizes the importance of robust infection control practices to prevent the spread of NDM-CRE. These practices include meticulous hand hygiene, the use of gloves and gowns during patient care, and thorough cleaning and disinfection of healthcare environments. Enhanced Barrier Precautions are recommended in long-term care facilities, even as Contact Precautions are advised in acute care settings.
Beyond infection control, prompt and accurate testing is crucial. The CDC urges healthcare providers to stay informed about the increasing threat of NDM-CRE and to understand the local epidemiology of CRE in their area. When a CRE infection is identified, testing to determine the specific carbapenemase present—like NDM—is essential to guide appropriate antibiotic selection.
What’s Being Done and What’s Next?
The CDC is actively working to address the growing threat of NDM-CRE through several initiatives. These include strengthening surveillance efforts to track the spread of the bacteria, providing guidance to healthcare facilities on infection control practices, and supporting research to develop new diagnostic tools and treatment options. The CDC also collaborates with state and local Healthcare-associated Infections and Antimicrobial Resistance (HAI/AR) Programs to prevent the spread of NDM-CRE within communities.
The exact reasons for the recent surge in NDM-CRE infections are still under investigation. Contributing factors likely include gaps in infection control, limited testing capabilities, and the broader issue of antibiotic resistance. Addressing these challenges will require a coordinated effort from healthcare providers, public health agencies, and researchers.
The full report, Changes in Carbapenemase-Producing Carbapenem-Resistant Enterobacterales, 2019–2023, provides a detailed analysis of the trends and challenges associated with NDM-CRE. For more information on NDM-CRE and how to prevent its spread, visit the CDC’s CRE website or the Antimicrobial Resistance Laboratory Networks page.
The CDC plans to release updated guidance on CRE testing and treatment in the coming months, based on the latest research and data. Continued vigilance and a proactive approach are essential to mitigate the threat posed by NDM-CRE and protect public health.
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