Surge in Antibiotic-Resistant Infections Alarms Health Officials

Infections caused by New Delhi metallo-β-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) have surged by over 460% in the United States between 2019 and 2023, according to a recent report from the Centers for Disease Control and Prevention (CDC). These bacteria are resistant to nearly all antibiotics, making infections extremely difficult to treat and posing a significant public health threat.

The CDC's analysis, published in the Annals of Internal Medicine, indicates that the incidence of NDM-CRE infections increased from approximately 0.25 cases per 100,000 people in 2019 to about 1.35 per 100,000 in 2023. This sharp rise underscores the growing challenge of antimicrobial resistance and the urgent need for enhanced detection, infection control measures, and responsible antibiotic use.

NDM-CRE refers to Enterobacterales bacteria that produce the New Delhi metallo-β-lactamase enzyme, rendering them resistant to carbapenems, a class of last-resort antibiotics. This resistance leaves very limited treatment options, often involving expensive, intravenous-administered drugs. Infections caused by NDM-CRE can include pneumonia, bloodstream infections, urinary tract infections, and wound infections, all of which are extremely hard to treat and can be deadly.

Danielle Rankin, an epidemiologist in CDC's Division of Healthcare Quality Promotion, emphasized the gravity of the situation:

"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."

Experts suggest that increased antibiotic use during the COVID-19 pandemic may have contributed to the rise in NDM-CRE infections. Dr. Jason Burnham, a Washington University researcher, noted:

"We know that there was a huge surge in antibiotic use during the pandemic, so this likely is reflected in increasing drug resistance."

The surge in NDM-CRE infections poses significant challenges to public health:

• Healthcare Impact: Increased infections can lead to longer hospital stays, higher medical costs, and greater strain on healthcare resources.

• Community Spread: The potential for community transmission raises concerns about the spread of these resistant bacteria beyond healthcare settings.

• Antibiotic Stewardship: The rise underscores the urgent need for responsible antibiotic use and enhanced infection control measures.

While NDM-CRE infections were once rare and primarily associated with international medical care, their domestic spread has increased significantly in recent years. The current surge represents a substantial escalation compared to previous data.

The CDC urges healthcare providers to:

• Stay Informed: Be aware of the increasing threat of NDM-CRE nationally and understand local CRE epidemiology.

• Test Promptly: Perform testing to identify the type of carbapenemase present to help get patients effective treatment promptly when a CRE infection is identified.

• Select Treatment Carefully: Understand the specific carbapenem resistance mechanism causing the infection to appropriately select antibiotics to manage NDM-CRE infections.

• Strengthen Prevention: Follow infection prevention and control best practices to protect patients and keep bacteria from spreading in healthcare settings.

The CDC's report on the sharp rise in NDM-CRE infections serves as a critical reminder of the ongoing battle against antibiotic-resistant bacteria. It underscores the necessity for vigilant infection control, responsible antibiotic use, and continued research to develop effective treatments.