A CDC report links the rapid growth of NDM-CRE to testing gaps and urges the prompt use of carbapenemase testing, mechanism-guided therapy, and stronger infection prevention measures.
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US infections caused by NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE) increased by more than 460% from 2019 to 2023, according to a Centers for Disease Control and Prevention (CDC) analysis published in Annals of Internal Medicine. CDC cautions that this surge could raise overall carbapenem-resistant Enterobacterales (CRE) infections and deaths beyond prior national estimates.
NDM-CRE cause pneumonia, bloodstream, urinary tract, and wound infections and are resistant to many available antibiotics, leaving limited treatment options. Detection is frequently delayed because many clinical laboratories do not routinely perform carbapenemase testing, complicating targeted therapy and control measures.
The Annals report describes trends in carbapenemase-producing CRE (CP-CRE) identified through CDC’s Antimicrobial Resistance Laboratory Network during 2019–2023. CP-CRE increased overall, with the steepest growth in organisms carrying NDM (New Delhi metallo-β-lactamase), a metallo-β-lactamase that historically was less common in the United States than KPC but is now rising rapidly.
From 2019–2023, NDM-CRE increased by more than 460% in US surveillance, driving broader growth in carbapenemase-producing CRE.
Limited carbapenemase testing delays targeted treatment and control; many labs lack routine capacity, so true burden is likely underestimated.
CDC advises prompt carbapenemase testing, resistance-mechanism–guided antibiotic selection, and reinforced Contact/Enhanced Barrier Precautions coordinated with state/local HAI/AR programs.
Findings reflect isolates from participating jurisdictions and laboratory submissions rather than a population-based national count. Incomplete carbapenemase testing and the absence of several high-population states indicate that absolute numbers likely underestimate the US burden.
A 2022 CDC special report estimated ~12,700 CRE infections and 1,100 deaths in 2020. The documented rise in NDM-CRE threatens to increase those totals. Contributing factors under evaluation include gaps in infection prevention and control and limited access to rapid carbapenemase testing.
CDC advises clinicians to: stay informed about local CRE epidemiology; test promptly to identify the carbapenemase mechanism when CRE is detected; select therapy based on the resistance mechanism; and strengthen infection-prevention practices (e.g., Contact Precautions in acute care and Enhanced Barrier Precautions in long-term care). Facilities should coordinate with state and local HAI/AR programs to enhance detection and limit spread.
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