The 460% Surge in Drug-Resistant Bacteria: Why Hand Hygiene Has Never Mattered More

A recent CDC report has revealed a troubling trend: a specific type of highly resistant bacteria has increased more than fourfold in just four years. For healthcare facilities working to protect patients and prevent hospital-acquired infections (HAIs), this development reinforces why foundational infection prevention practices remain critical.

A Growing Threat to Patient Safety

Between 2019 and 2023, NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE) infections increased by over 460% across the United States. These organisms resist nearly every antibiotic clinicians have available, creating situations where infections become extremely challenging or impossible to treat effectively.

The bacteria cause various serious infections—from pneumonia to bloodstream infections—and carry significant risks for patients. In 2020, these organisms contributed to over twelve thousand infections and more than one thousand deaths nationwide.

Understanding the NDM-CRE Threat

NDM refers to New Delhi metallo-β-lactamase, an enzyme that makes these types of bacteria resistant to almost all available antibiotics. What makes NDM-CRE particularly dangerous is the combination of its resistance profile and its potential for rapid spread.

Many healthcare providers may be unaware of NDM-CRE or lack access to rapid testing tools that identify the specific resistance mechanism. Early evidence points to gaps in infection control practices and limited testing capacity across clinical settings as key contributing factors to the surge.

The implications are sobering: when antibiotics fail, prevention becomes the primary—and sometimes only—line of defense against these deadly infections.

The Broader Pattern of Antimicrobial Resistance

NDM-CRE isn’t the only drug-resistant organism on the rise. Clinical cases of Candida auris, a drug-resistant fungus, jumped more than 50% from 2022 to 2023. This parallel surge suggests a broader pattern of antimicrobial resistance gaining ground in healthcare settings.

What makes these simultaneous increases concerning is their different origins. NDM-CRE is bacterial, while Candida auris is fungal—two completely different types of organisms that require different treatments under normal circumstances. Bacteria respond to antibiotics; fungi require antifungals. Yet both are developing resistance at alarming rates, and both spread through similar pathways in healthcare environments.

This distinction matters because it reveals that antimicrobial resistance isn’t confined to one class of organisms or one type of medication. The problem spans across multiple categories of pathogens, suggesting that the underlying drivers—such as inconsistent infection prevention practices—are affecting a wide range of organisms simultaneously. Healthcare facilities can’t simply focus on preventing bacterial infections or fungal infections; they must address the fundamental transmission routes that allow all types of resistant organisms to spread.

The Stakes Have Changed

The emergence of NDM-CRE fundamentally changes the risk calculus for healthcare-associated infections. When effective antibiotics were readily available, a HAI—while serious—could typically be treated. Today, with many organisms resistant to antibiotics, a single transmission event could lead to an untreatable infection.

This shift makes prevention a best practice and an absolute necessity. Healthcare facilities can no longer afford gaps in hand hygiene compliance or inconsistent infection control practices. The margin for error has essentially disappeared.

The Financial and Operational Impact

The rise of drug-resistant organisms compounds the already significant costs associated with healthcare-associated infections. As we’ve explored in previous discussions about the hidden legal and financial costs of HAIs, infections don’t just impact patient outcomes—they create substantial financial exposure through direct treatment expenses, legal settlements, and regulatory penalties.

According to CDC estimates, treating just six of the most concerning drug-resistant threats contributes more than $4.6 billion in healthcare costs annually across the United States. These estimates account for medical personnel, equipment, and the space required to care for infected patients. Notably, this figure doesn’t capture downstream costs occurring after initial hospitalization or the broader economic impact on patients themselves—suggesting the actual financial toll runs considerably higher.

Beyond direct costs, these infections strain operational capacity. Staff must implement enhanced isolation protocols, dedicate additional time to complex care regimens, and manage the psychological burden of treating patients with limited therapeutic options. This growing burden makes the case for prevention strategies that stop transmission before these complex care scenarios unfold.

Hand Hygiene: The Common Denominator

Regardless of whether an organism is bacterial or fungal, resistant or susceptible, hand hygiene remains the most effective intervention for preventing transmission in healthcare settings. The CDC’s recommendations in response to the NDM-CRE surge center on this fundamental practice, alongside appropriate use of protective equipment and robust infection control protocols.

The CDC advises healthcare providers to take these concrete steps to address the rising threat of NDM-CRE and other resistant pathogens:

• Stay vigilant about emerging threats.
  Monitor national trends in antimicrobial resistance while understanding the specific patterns occurring in your local area and facility.
• Prioritize rapid identification.
  When resistant infections are suspected, pursue specialized testing through your clinical laboratory or public health lab to determine the exact resistance mechanisms present. This information guides effective treatment decisions.
• Apply evidence-based prevention protocols.
  Implement appropriate barrier precautions based on your care setting—whether contact precautions in acute care or enhanced barrier precautions in long-term care. Collaborate with local HAI/AR programs to strengthen infection control efforts.
• Maintain rigorous hand hygiene practices.
  Ensure compliance at every opportunity: before and after patient contact, before procedures, after exposure to body fluids, and after touching patient environments.

Infection prevention cannot be approached casually. Each hand hygiene moment represents an opportunity to stop the transmission of organisms that may resist all available treatments. 

Ultimately, the three essential elements of effective infection prevention remain unchanged: electronic hand hygiene monitoring, systematic behavior change, and organizational cultures where prevention becomes every team member’s responsibility.