The resistance gene that’s causing ‘nightmares’ in US hospitals - CIDRAP

What the report says

CIDRAP News, published by the University of Minnesota, reports that U.S. health officials are increasingly concerned about carbapenem-resistant Enterobacterales, or CRE, carrying the New Delhi metallo-beta-lactamase gene, known as NDM. The article recalls a 2016 Nevada case involving a 70-year-old woman whose Klebsiella pneumoniae infection resisted all 26 antibiotics available to clinicians; investigators believed she likely acquired it after hospitalization in India, where NDM was first identified. CIDRAP says the situation has shifted: a CDC report last September found NDM-carrying CRE infections rose 461% from 2019 to 2023 in national lab surveillance.

The concern is clinical as well as epidemiological. CRE infections are already difficult because they often affect severely ill hospital patients and can have high mortality. CIDRAP cites experts saying NDM-CRE is especially challenging because some newer antibiotic combinations designed for other carbapenemase-producing bacteria do not work against it. Newer options exist, but CDC officials and physicians quoted in the report said treatment depends on quickly identifying the NDM mechanism, while many labs lack the molecular testing needed.

CIDRAP also highlights why NDM may spread in complicated ways. Researchers said the gene is usually carried on plasmids, mobile DNA elements that can move between bacterial species. That means hospitals may face outbreaks involving several organisms rather than a single strain. The article cites a 2024 UPMC Presbyterian Hospital study involving 15 patients and seven bacterial species.

Beyond hospitals, CIDRAP reports that wastewater testing from 163 U.S. sites found NDM in varying concentrations, with higher levels in some communities that included hospitals and nursing homes, especially in southern and western states. The findings suggest surveillance could help detect where this resistance threat is growing.