A new report from the Centers for Disease Control and Prevention (CDC), published in the Annals of Internal Medicine, highlights a dramatic increase in a dangerous type of drug-resistant bacteria called NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE).
In a 2022 special report, COVID-19: U.S. Impact on Antimicrobial Resistance, CDC noted that in 2020 there were approximately 12,700 infections and 1,100 deaths in the U.S. due to CRE. The rise in NDM-CRE, documented in the new study, threatens to increase CRE infections and deaths.
Between 2019 and 2023, NDM-CRE infections surged by more than 460% in the United States. These infections —including pneumonia, bloodstream infections, urinary tract infections, and wound infections—are extremely hard to treat and can be deadly. Detection is also challenging, as many clinical laboratories lack the necessary testing capacity.
“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.”
What is NDM-CRE?
NDM-CRE is part of a group of bacteria known as carbapenem-resistant Enterobacterales (CRE), which are resistant to some of the strongest antibiotics available. “NDM” refers to New Delhi metallo-β-lactamase, an enzyme that makes these bacteria resistant to nearly all available antibiotics, leaving few treatment options.
Why This Matters:
• NDM-CRE infections are difficult to treat: There are few effective treatment options for NDM-CRE infections. Because NDM-CRE has historically been uncommon in the United States, healthcare providers might not suspect it when treating patients with CRE infections. This can lead them to pick a treatment that is not effective.
• NDM-CRE is a serious risk for patients and is associated with high rates of morbidity and mortality: NDM-producing CRE (NDM-CRE) are resistant to most available antibiotics, and NDM-CRE infections are associated with high rates of morbidity and mortality.
• NDM-CRE has the potential to spread quickly: Without appropriate infection prevention and control measures, NDM-CRE can move through healthcare settings and into the community.
• NDM-CRE is a global challenge: NDM-CRE has been detected around the world, and travel increases the risk of it spreading to previously unaffected communities.
The exact reasons for the surge are still being studied, but contributing factors may include:
• Gaps in infection control: Consistent infection control practices – such as hand hygiene, wearing gloves and gown during patient care, and proper cleaning and disinfection – help to prevent bacteria like NDM-CRE from spreading in healthcare settings.
• Limited testing: Many hospitals and clinics do not have the tools to rapidly detect NDM-CRE infections or the presence of these dangerous germs in patients who aren’t yet sick. Delayed identification leads to slower treatment, increased transmission, and missed opportunities for infection control.
CDC urges healthcare providers to:
• Stay Informed: Be aware of the increasing threat of NDM-CRE nationally. Understand your local CRE epidemiology.
• Test Promptly: Perform testing to identify the type of carbapenemase present to help get your patient effective treatment promptly when a CRE infection is identified. Testing is available in some clinical laboratories, and, if unavailable at the clinical level, through public health laboratories.
• Select treatment carefully: Understand the specific carbapenem resistance mechanism causing the infection to appropriately select antibiotics to manage your patient’s NDM-CRE infection.
• Strengthen prevention: Follow infection prevention and control best practices to protect patients and keep bacteria from spreading in healthcare settings, including wearing a gown and gloves for patient care according to the guidelines for your setting (i.e., Contact Precautions in acute care, Enhanced Barrier Precautions in long-term care). Work with state/local Healthcare-associated Infections and Antimicrobial Resistance (HAI/AR) Programs to prevent spread.
The full report, Changes in Carbapenemase-Producing Carbapenem-Resistant Enterobacterales, 2019–2023, is available HERE.
For more information on NDM-CRE and how to prevent its spread, visit: https://www.cdc.gov/cre/about/index.html or https://www.cdc.gov/antimicrobial-resistance-laboratory-networks/php/about/domestic.html.
Source: CDC