In September 2025, the Centers for Disease Control and Prevention (CDC) published new data in the Annals of Internal Medicine showing a dramatic increase in infections caused by a highly drug-resistant pathogen: NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE). These organisms are part of a broader group of bacteria known as carbapenem-resistant Enterobacterales (CRE), which are resistant to some of the strongest antibiotics available.
According to the CDC, infections caused by NDM-CRE increased more than 460 percent between 2019 and 2023 in the United States. These infections include pneumonia, bloodstream infections, urinary tract infections, and wound infections, and are often extremely difficult to treat. The sharp increase raises concern about the growing threat posed by antimicrobial resistance, particularly for medically vulnerable populations.
NDM refers to New Delhi metallo-β-lactamase, an enzyme that makes these bacteria resistant to nearly all available antibiotics. Because NDM-CRE has historically been uncommon in the United States, healthcare providers might not suspect it when treating patients with CRE infections. Many clinical laboratories currently lack the ability to detect NDM-CRE, which can delay treatment and allow for further spread within healthcare environments.
The CDC recommends several actions for healthcare providers:
- Stay informed about the increasing threat of NDM-CRE and be aware of regional trends in carbapenem-resistant infections.
- Promptly test to identify the type of carbapenemase when a CRE infection is detected, using available lab resources or public health laboratory support.
- Select antibiotics carefully, based on the resistance mechanism identified, to ensure the best chance of treatment success.
- Strengthen infection control practices to prevent the spread of resistant organisms, including the use of gowns and gloves as appropriate, and partnering with local public health programs for support.
Access the CDC’s press release here.
Compliance Perspective
Issue
The recent increase in infections caused by NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE) underscores the need for continued attention to antimicrobial resistance across healthcare settings. These infections are difficult to treat and can contribute to poorer outcomes due to limited antibiotic options and delays in appropriate therapy. Detection of NDM-CRE remains a challenge for many facilities, as not all clinical laboratories are equipped to identify specific resistance mechanisms. The CDC emphasizes that facilities should ensure their infection prevention and control programs, along with their antimicrobial stewardship practices, are equipped to detect, contain, and manage emerging resistant pathogens. A proactive and coordinated approach supports both resident safety and regulatory compliance.
Discussion Points
- Review infection prevention and control policies and procedures to ensure they reflect the most recent CDC recommendations, including specific guidance related to resistant organisms such as NDM-CRE. It may be beneficial to work with a consultant experienced in regulatory compliance or legal interpretation to identify any potential gaps and ensure alignment with federal and state requirements.
- Provide regular training for all staff on infection control protocols and antibiotic stewardship practices, including the identification and management of resistant organisms. Med-Net Academy offers the course Antibiotic Stewardship, which helps staff understand the dangers of antibiotic overuse and teaches the core elements of stewardship in nursing homes. The course covers leadership roles in stewardship, communication with clinical providers, and implementation of infection control measures.
- Conduct audits of infection prevention and control practices as well as antimicrobial stewardship activities to confirm that protocols are consistently followed and effectively implemented. Mock surveys or focused reviews—particularly when performed in collaboration with a consultant familiar with infection control and quality improvement—can help facilities identify areas for improvement and support ongoing compliance efforts.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*