US CDC Reports 460% Surge in Deadly Drug-Resistant NDM-CRE Infections

Danielle Rankin, PhD, MPH

Courtesy of Vanderbilt University School of Medicine

A new analysis from the US Centers for Disease Control and Prevention (CDC) shows a dramatic increase in infections caused by New Delhi metallo-β-lactamase (NDM)–producing carbapenem-resistant Enterobacterales (NDM-CRE), a highly drug-resistant and difficult-to-treat group of bacteria. The report, published September 2025 in Annals of Internal Medicine, highlights a >460% increase in NDM-CRE infections between 2019 and 2023.

CRE are resistant to carbapenems, antibiotics often considered a last line of defense. NDM-CRE, defined by the presence of the NDM enzyme, are resistant to nearly all available antibiotics, leaving clinicians with few treatment options. These infections include pneumonia, bloodstream infections, urinary tract infections, and wound infections, all associated with high morbidity and mortality.

The CDC previously reported approximately 12 700 infections and 1 100 deaths due to CRE in 2020. The rise in NDM-CRE threatens to increase those totals.

“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,” corresponding author Danielle Rankin, MPH, an epidemiologist in CDC’s Division of Healthcare Quality Promotion, said in a press release. “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.”

The exact causes of the surge are not fully established. Investigators cite several potential contributing factors, including inconsistent infection control practices, gaps in testing capacity, and the ability of NDM-CRE to spread quickly in healthcare and community settings. Because NDM-CRE has historically been rare in the United States, clinicians may not suspect it when treating CRE infections, increasing the risk of ineffective antibiotic selection.

The CDC report recommends that health care providers:

• Stay informed about national and local CRE epidemiology.
• Test promptly to identify carbapenem resistance mechanisms when CRE infections are detected.
• Select treatment carefully based on the specific resistance mechanism present.
• Strengthen prevention through consistent use of gloves, gowns, and cleaning practices, with guidance adapted to care setting (eg, contact precautions in acute care, enhanced barrier precautions in long-term care).

The CDC emphasized that timely identification and infection prevention are essential to limiting spread and reducing the impact of NDM-CRE in the US.

References:

1. Rankin D, et al. Changes in Carbapenemase-Producing Carbapenem-Resistant Enterobacterales, 2019–2023. Ann Intern Med. Published online September 23, 2025. doi:10.7326/ANNALS-25-02404
2. CDC Report Finds Sharp Rise in Dangerous Drug-Resistant Bacteria. CDC. September 23, 2025. Accessed September 24, 2025. https://www.cdc.gov/media/releases/2025/2025-cdc-report-finds-sharp-rise-in-dangerous-drug-resistant-bacteria.html