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). According to CDC data, between 2019 and 2023, cases of NDM-CRE rose by more than 460% across the United States.
These bacteria are resistant to some of the most powerful antibiotics available. Infections can include pneumonia, bloodstream infections, urinary tract infections, and wound infections. The report notes that these infections are extremely difficult to treat and can be fatal. Detection is also complicated because many clinical laboratories do not have the capacity for specialized testing.
“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. As a result, there are few effective treatments available. The CDC warns that since NDM-CRE was previously uncommon in the U.S., healthcare providers may not suspect it when treating patients with CRE infections, potentially leading to ineffective treatments.
The CDC emphasizes that NDM-CRE poses a serious risk due to its association with high rates of illness and death. The agency also highlights concerns about its potential for rapid spread within healthcare settings and into communities if infection control measures are not strictly followed.
Contributing factors to this surge may include lapses in infection control practices such as hand hygiene and proper use of protective equipment during patient care. Additionally, limited testing capabilities at many hospitals delay identification and treatment of these dangerous bacteria.
The CDC advises healthcare providers to stay informed about local trends in CRE infections, perform prompt testing for carbapenemase types when CRE is detected, carefully select antibiotic treatments based on resistance mechanisms, and follow best practices for infection prevention and control. The agency recommends working with state or local programs focused on healthcare-associated infections and antimicrobial resistance.
Further information about NDM-CRE can be found on the CDC’s website at https://www.cdc.gov/cre/about/index.html or https://www.cdc.gov/antimicrobial-resistance-laboratory-networks/php/about/domestic.html.
