Infection rates are dramatically increasing in the United States due to a dangerous type of bacteria that is resistant to some of the strongest antibiotics available. This alarming trend has prompted infectious disease experts to issue warnings regarding the challenges of managing this surge. The Centers for Disease Control and Prevention (CDC) reported this week that between 2019 and 2023, infections caused by a “superbug” known as NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE) surged by more than 460% in the U.S.
NDM-CRE is a specific type of bacteria that possesses a unique gene capable of breaking down powerful antibiotics, rendering most drug treatments ineffective. Shruti Gohil, an associate professor of infectious diseases at the UC Irvine School of Medicine, emphasized that “this makes these ‘superbug’ bacteria very hard to treat because they’re resistant to some of the strongest antibiotics we have.” The CDC's findings, which were initially published in a 2022 report, noted about 12,700 infections and 1,100 deaths attributed to this drug-resistant bacteria in the U.S. during 2020.
While the CDC did not pinpoint the exact reason for this alarming surge in NDM-CRE infections, there is a noted association with the use of antibiotics during the early stages of the COVID-19 pandemic. According to Neha Nanda, medical director of antimicrobial stewardship at USC’s Keck Medicine, the increased use of antibiotics in treating COVID-19 patients may have contributed to the rise of NDM-CRE. Public health officials caution that NDM-CRE has not been historically common in the U.S., which may lead healthcare providers to overlook this infection when treating patients.
The CDC warns that the rise of NDM-CRE infections poses a significant threat, potentially leading to increased rates of infection and mortality associated with this bacteria. This report marks the second time the CDC has highlighted the uptick in bacteria-related cases, with the most recent report focusing on New York City between 2019 and 2024.
Individuals infected with NDM-CRE bacteria typically do not show symptoms unless they develop an infection. Once an infection occurs, symptoms can vary widely and may include pneumonia, bloodstream infections, urinary tract infections, and wound infections. Common symptoms may consist of fever, chills, cough, shortness of breath, and pain or blood in urine if the urinary tract is affected. Due to the bacteria’s resistance to most antibiotics, treatment options are alarmingly limited, which can lead to slower recovery and a higher risk of serious complications or even death, as noted by Gohil.
Another significant concern is the bacteria's ability to spread to others and survive on contaminated surfaces. While doctors can test for NDM-CRE, most individuals do not require testing unless they are at an elevated risk. Those at higher risk include individuals who have been hospitalized (especially overseas), have undergone repeated antibiotic treatments, have had invasive medical procedures, or have been in contact with someone known to have NDM-CRE.
Testing for this bacteria poses challenges, as many hospitals and clinics lack the necessary tools for rapid detection, even in patients who do not exhibit symptoms.
The rise of NDM-CRE infections can be traced back to the overuse of powerful antibiotics. Nanda suggests this situation presents an opportunity to change the narrative surrounding antibiotic prescriptions. Patients should actively engage with their healthcare providers by asking why antibiotics are necessary and exploring all treatment options before resorting to antibiotics. “If you need it, you need it, but then be judicious about it,” she advised.
Given that NDM-CRE infections primarily affect very sick individuals—particularly those in hospitals or long-term care facilities—experts recommend that patients, healthcare staff, and visitors in these environments practice stringent hand hygiene and avoid contact with contaminated surfaces to mitigate the spread of these dangerous infections.
