Rise of Drug-Resistant “Nightmare Bacteria” Threatens US Health

The prevalence of drug-resistant “nightmare bacteria” in the United States has surged significantly, according to a recent report from the US Centers for Disease Control and Prevention (CDC). From 2019 to 2023, infections caused by these bacteria increased by almost 70 percent, with the rate of cases rising more than fivefold during this period. This alarming trend highlights the urgent need for public health interventions and increased awareness.

The rise in these infections is primarily attributed to bacteria carrying the NDM gene, which confer resistance to a limited number of antibiotics. Researchers noted that only two antibiotics are effective against these infections, and both require intravenous administration, making treatment costly and accessible only in clinical settings. The research published in the *Annals of Internal Medicine* underscores the growing threat posed by these pathogens, which were once confined to a small cohort of patients who had received medical care abroad.

The implications of this trend are profound. “The rise of NDMs in the US is a grave danger and very worrisome,” stated David Weiss, an infectious diseases researcher at Emory University. Many individuals may unknowingly carry these drug-resistant bacteria, leading to potential community transmission. Dr. Maroya Walters, another author of the report, warned that infections traditionally viewed as routine—such as urinary tract infections—could evolve into chronic health issues.

Antimicrobial resistance occurs when bacteria and fungi develop the ability to withstand the effects of medications designed to eliminate them. Misuse of antibiotics, including incomplete or unnecessary prescriptions, has been a significant factor in this rise, strengthening the bacteria over time. The CDC has previously highlighted the threat of “nightmare bacteria,” particularly those resistant to carbapenems, a class of last-resort antibiotics for severe infections.

The researchers evaluated data from 29 US states that conduct testing and reporting of carbapenem-resistant bacteria. They identified 4,341 cases of such infections in 2023, with 1,831 specifically attributed to the NDM variety. The rate of carbapenem-resistant infections increased from just under 2 per 100,000 people in 2019 to over 3 per 100,000 in 2023, reflecting a 69 percent escalation. Notably, NDM cases saw an even steeper rise, jumping from around 0.25 to approximately 1.35 per 100,000 people—an increase of 460 percent.

The COVID-19 pandemic has likely exacerbated this situation. “We know that there was a huge surge in antibiotic use during the pandemic, so this likely is reflected in increasing drug resistance,” explained Dr. Jason Burnham, a researcher at Washington University. The CDC’s findings are not exhaustive; many states do not fully test or report cases, and even in those that do, infections are often found only among hospital patients requiring specialized testing. Furthermore, some of the most populous states, including California, Florida, New York, and Texas, did not submit data, suggesting that the actual number of US infections is likely underestimated.

This report is not the first to raise alarms about rising drug-resistant infections. A previous CDC report from June noted an increase in NDM cases specifically in New York City from 2019 to 2024. As the healthcare community grapples with the implications of these findings, the need for robust public health strategies and responsible antibiotic use has never been more critical.