CIDRAP-CDC report shows rise in drug-resistant infections, deaths in US

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CDC report shows rise in drug-resistant infections, deaths in US

www.cidrap.umn.edu

CDC report shows rise in drug-resistant infections, deaths in US​

Chris Dall, MA

Today at 3:28 p.m.
Antimicrobial Stewardship


New data from the Centers for Disease Control and Prevention (CDC) released today show the nation has seen a substantial increase in the number of infections caused by drug-resistant pathogens.

According to the CDC’s latest Antimicrobial Resistance [AR] Threats Report, drug-resistant bacteria and fungi cause an estimated 9.7 million infections in the United States each year, up from 2.8 million in a similar report issued in 2019. The estimated number of US deaths caused by drug-resistant pathogens rose from 35,000 to 50,800.

Infections that commonly occur in hospital patients accounted for more than 42,000 US deaths and cost the US healthcare system more than $12 billion, according to the report.

The findings are based on data collected in 2023. CDC officials say the jump in drug-resistant infections since the 2019 report partially reflects actual increases in the number of infections caused by some resistant bacteria and fungi. But they note that their data sources and methodologies have changed substantially and that direct comparisons between the two reports should not be made.

Still, the agency and infectious disease experts say the report highlights what is both a current and future health threat.

“Antimicrobial resistance threatens modern medicine and puts millions of Americans at risk every year,” CDC Director Erica Schwartz, MD, MPH, JD, said in a press release.

“These numbers are alarming by any measure but are particularly sobering when infectious diseases physicians connect real patients with these statistics in their everyday experience,” Infectious Diseases Society of America (IDSA) President Wendy Armstrong, MD, said in a statement.

Multidrug-resistant pathogens pose an urgent threat​

The CDC report highlights the 19 drug-resistant pathogens responsible for the 9.7 million annual infections—four of them labeled as urgent threats, 13 as serious threats, and two as concerning threats—along with a “watch list” of six additional pathogens the agency is keeping an eye on.

Topping the list of urgent threats identified by the CDC is Candida auris, a fungus that’s almost completely resistant to one class of antifungal medications and has shown emerging resistance to the other two. C auris was first detected in US hospitals just 10 years ago but caused 4,523 infections in 2023—a 10-fold increase from 2019. The fungus is often found on patients’ skin, spreads rapidly in healthcare settings, and affects some of the most vulnerable patients.

Tom Chiller, MD, MPHTM, former chief of the Mycotic Diseases Branch at the CDC, said the limited number of antifungal medications makes it challenging to treat resistant C auris infections, which are fatal in 29% to 62% of patients.

“We need more drug development for sure,” Chiller, now chief medical officer for the fungal diagnostics company IMMY, told CIDRAP News. “For C auris we also need to figure out how to decolonize patients and rapidly disinfect healthcare environments. This will require lots more screening of patients and healthcare settings.”

Other urgent threats are carbapenem-resistant Enterobacterales (CRE), a family of multidrug-resistant bacterial pathogens that have become increasingly difficult to treat and can share their resistance with other bacteria. Like C auris, these bacteria pose the greatest threat to hospital patients, particularly those who have indwelling devices like ventilators and catheters. In a study published in September 2025, CDC researchers found CRE incidence at US hospitals increased 18% from 2019 to 2023.

“We are seeing more incidences of CRE in our hospital compared with five years ago,” said Haley Ann Pritchard, MD, an IDSA spokesperson and medical director of infection prevention and antimicrobial stewardship at Eskenazi Health Hospital in Indianapolis.

Pritchard added that, while there are newer antibiotics for CRE infections, she’s already seen resistance to drugs that have come out within the past few years. “We really need more drugs,” she said.

These numbers are alarming by any measure but are particularly sobering when infectious diseases physicians connect real patients with these statistics in their everyday experience.

Though urgent threats are primarily healthcare-associated, hospital patients aren’t the only ones who need to be concerned about drug resistance. Of the 14,878 CRE cases in 2023, 67% were community-onset, though some of those cases may have been in people with recent healthcare exposure, the CDC said.

Also making the urgent threats list is Neisseria gonorrhea, the bacterium that causes gonorrhea, one of the most common sexually transmitted infections. “Healthcare providers only have a few antibiotics that can effectively treat this infection,” the report states.

Without effective treatment, gonorrhea can cause pelvic inflammatory disease, ectopic pregnancy, and infertility. It can also increase the risk of HIV infection.

Decline in​

One pathogen that has been downgraded from an urgent to serious threat is Clostridioides difficile, a bacterium that causes severe diarrhea and damage to the colon. Though the pathogen still caused more than 11,000 deaths in US hospital patients in 2023, the number of C difficile infections declined by 9% from 2018 to 2023.

The CDC attributes the decline to better infection control and improved antibiotic use in hospitals (unnecessary antibiotic use is a primary cause of C diff infections).

“This data shows both the progress we've made and the significant work that remains,” Schwartz said.

Pritchard, who’s also an associate professor of clinical medicine at Indiana University School of Medicine, said the decline tells her that US hospitals are seeing some benefit from all the work they’re doing to prevent C difficile transmission.

“I would obviously like to see those numbers go down more, but it is at least nice that they’ve gone down some,” she said.

Other serious threats highlighted in the report are drug-resistant Campylobacter, a leading cause of foodborne illness; methicillin-resistant Staphylococcus aureus; drug-resistant Shigella, which spreads through contaminated food and water but has become increasingly associated with sexual activity; and multidrug-resistant Pseudomonas aeruginosa.

Newly added to the serious threats list is antibiotic-resistant Neisseria meningitidis, which cause meningococcal disease, a rare but life-threatening illness. “Between 2019 and 2023, the estimated number of ciprofloxacin-resistant N. meningitidis cases more than doubled, and the estimated number of penicillin-resistant cases tripled,” the CDC said.

Potential threats​

Pathogens on the CDC’s “watch list” include Bordetella pertussis, the bacteria that causes whooping cough (pertussis), which primarily affects young children. Macrolide antibiotics like azithromycin are typically used to treat pertussis cases, but two US cases of macrolide-resistant B pertussis were identified in 2024 and 2025, the first since 2018. The CDC says if macrolide resistance becomes more common, it may lead to more severe infections or deaths, particularly in young children.

The report also highlights drug-resistant dermatophytes, a group of fungi that cause skin infections like ringworm and athlete’s foot. Though the CDC says the overall burden of drug-resistant dermatophytes is not well understood, more cases are being reported in the United States and globally, and Chiller says that they can account for more than half of the cases seen at clinics in India.

You really cannot have all the benefits of modern medicine, even outside the realm of infectious diseases, without effective antibiotics. It all goes away.

Chiller says while these are not deadly infections, he’s worried that the resistant strains will take over and become increasingly difficult to treat. He’s also worried about the emergence of new fungal species that are even more resistant to current drugs.

“I am definitely concerned about the increasing trends of new emerging species and lack of good diagnostic options and new therapeutic approaches,” he said.

Pritchard said the importance of rising antimicrobial resistance goes far beyond the ability to treat infections.

“Every joint replacement, every appendectomy, every surgery relies on having effective antibiotics to be successful,” she said. “You really cannot have all the benefits of modern medicine, even outside the realm of infectious diseases, without effective antibiotics. It all goes away.”