What To Know About ‘Nightmare Bacteria’ Surging in the US

Infection rates from drug-resistant “nightmare bacteria” are on the rise in the U.S.—meaning that it is important to be aware of the risks, causes and how to slow the spread.

The surge comes as part of what the World Health Organization (WHO) has dubbed “one of the top global public health and development threats”: antimicrobial resistance (AMR).

AMR occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. Antimicrobials include antibiotics, antivirals, antifungals, and antiparasitics—all used to prevent and treat infectious disease. 

With this in mind, microbiologist professor Brenda Wilson of the University of Illinois Urbana-Champaign, has shared what you need to know about the surge of the deadly drug-resistant bacteria 'NDM-CRE' and AMR generally.

"Unfortunately, if the trends continue as they are, there will be a point where very few options are available to treat infections by highly drug-resistant bacteria, and researchers and healthcare providers are desperately seeking alternatives," Wilson told Newsweek.

In September, a Centers for Disease Control and Prevention (CDC) report on NDM-CRE—known as "nightmare bacteria"—found a 70 percent rise in such infections in the U.S. between 2019 and 2023.

The WHO has also just warned of widespread resistance to common antibiotics worldwide, presenting resistance prevalence estimates across 22 antibiotics used to treat infections of the urinary and gastrointestinal tracts, the bloodstream and gonorrhea.

Speaking to Illinois News Bureau biomedical sciences editor Liz Ahlberg Touchstone about the NDM-CRE rise, Wilson said, “NDM-CRE, or ‘nightmare bacteria,’ are a type of Enterobacterales bacteria that are resistant to the drug carbapenem. Carbapenem antibiotics are a ‘last resort’ class of broad-spectrum antibiotics that are used to treat severe infections, for which other commonly used antibiotics do not work. 

“They have the New Delhi metallo-β-lactamase gene, or NDM, making the already multidrug-resistant bacteria now resistant to nearly all antibiotics commonly used to fight these infections.”

Carbapenem may be used to treat severe forms of pneumonia; UTIs; foot, skin and soft tissue infections in people with diabetes; intra-abdominal infections and more. 

Wilson explained the resistance severely limits treatment options—often to only a few expensive, IV-administered antibiotics—and is associated with higher mortality rates of up to 40–50 percent, as infections often cannot be treated quickly enough.

“The CDC report has prompted health officials to urge increased testing, stricter infection control and careful antibiotic selection to prevent further spread,” she said.

The WHO also notes drug-resistant ‘Gram-negative bacteria’ are becoming more dangerous worldwide. Among these, E. coli and K. pneumoniae are the most resistant Gram-negative bacteria found in bloodstream infections. These are often the most severe bacterial infections—resulting in sepsis, organ failure and death if not treated properly or effectively. 

They report more than 40 percent of E. coli and over 55 percent of K. pneumoniae globally are now resistant to third-generation cephalosporins, the first-choice treatment for these infections. Meanwhile, they too warn carbapenems (and fluoroquinolones) are losing effectiveness against E. coli, K. pneumoniae, Salmonella, and Acinetobacter. 

Wilson said in any bacterial community there is already a significant portion that are either resistant to or are more tolerant of the presence of antibiotics. 

“When a bacterial population is treated with antibiotics, most of the bacteria in the community indeed will be killed—but, unfortunately, the drug-resistant or drug-tolerant bacteria can survive, grow and then dominate the community,” she explained. 

But, according to Wilson, one of the biggest problems we are now facing is the spread of antibiotic resistance to bacteria that did not previously have their own resistance. 

“The genes that enable a bacterium to be resistant to a particular antibiotic or class of antibiotics often can be transferred to other nearby bacteria, giving these other bacteria new antibiotic resistance properties," she said.

"Unfortunately, this gene transfer ability is quite prevalent and can transfer multiple different antibiotic resistance genes, such that some bacteria can acquire multiple resistances.”

Fortunately, there are measures to take to avoid contributing to the rise of antimicrobial resistance, with a heavy focus on better understanding and education.

“The major factors that contribute to antimicrobial resistance include the widespread release of antibiotics into the environment that increase the selective pressure of bacteria to acquire resistance genes to survive,” said Wilson.

“This includes things like sewage and agricultural runoff, but also individual health choices, such as overprescription or incorrect prescription by doctors and noncompliance with dosing regimens by patients.

“Educational efforts are needed for health professionals, agricultural industry stakeholders, patients and consumers that emphasize proper antibiotic use and preventive medicine such as good hygiene practices, vaccines, clean water, good nutrition and healthy lifestyles.

“We need to stop or more strictly regulate over-the-counter antibiotic sales and indiscriminate agricultural use. We need to improve water quality, sanitation, and hygiene to reduce disease and prevent antimicrobial resistance spread.”

There is also hope of breakthroughs to help create new drugs.

"Academic and industry scientists are researching and developing new twists on traditional approaches to antibiotic discovery and development, such as designing new chemical diversity of the drugs, developing new formulations with drug combinations and drug augmenters," Wilson told Newsweek.

"Some of these new approaches are being accelerated and streamlined by generative AI, bioinformatics and high-throughput technologies."

Alternative approaches include development of cost-effective rapid diagnostic tests for identifying and tracking resistant bacteria; monitoring disease progression; and applying tailored treatments and preventative measures like prebiotics, probiotics and microbiome therapies that promote health in the first place.