Cases of infections caused by so-called “nightmare bacteria”—pathogens resistant to nearly all available antibiotics, have surged nearly 70% between 2019 and 2023, according to a new report from the Centers for Disease Control and Prevention (CDC).

The findings, published Monday in the Annals of Internal Medicine, show that the sharp rise is largely linked to bacteria carrying the NDM gene (New Delhi metallo-β-lactamase), which makes infections exceptionally difficult to treat.

What are ‘nightmare bacteria’?

The term “nightmare bacteria” generally refers to a group of germs known as Carbapenem-resistant Enterobacteriaceae (CRE). This includes pathogens such as Escherichia coli (E. coli) and Klebsiella pneumoniae.

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• CRE infections are considered extremely dangerous because they resist carbapenems, a class of last-resort antibiotics often reserved for the sickest patients.
• The presence of the NDM gene further complicates treatment by neutralizing multiple types of antibiotics at once.

Initially, these infections were rare in the United States and often linked to patients who had received medical treatment abroad. But according to WION’s reporting, they are now increasingly appearing within U.S. hospitals and communities.

Why the recent surge?

CDC scientists note several factors contributing to the surge in NDM-linked cases:

• Global spread: Bacteria carrying the NDM gene are no longer confined to overseas cases.
• Hospital settings: Patients with invasive devices (like catheters or ventilators) are at higher risk.
• Limited treatments: Currently, only two antibiotics remain effective, both expensive and requiring IV administration.

While the total number of cases remains relatively small, infections tied to the NDM gene have increased more than fivefold in recent years, according to U.S. News.

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What are the early signs of infection?

Detecting CRE infections early is difficult because symptoms often resemble those of more common bacterial illnesses. Warning signs vary depending on the site of infection:

• Urinary tract infections (UTIs): Fever, painful urination, cloudy urine, and frequent urges.
• Lung infections (pneumonia): Cough, chest pain, fever, shortness of breath.
• Bloodstream infections (sepsis): High fever, chills, rapid heartbeat, low blood pressure, and confusion.

Because these symptoms overlap with other conditions, lab testing is essential for accurate diagnosis. Delayed detection can make effective treatment far more challenging.

Why this matters

Public health experts warn that the rise of CRE and the spread of the NDM gene marks a serious threat to modern medicine. With treatment options dwindling, everyday infections and routine surgeries could become much riskier.

Jennifer Ewbank, former CIA deputy director for digital innovation, told CNBC-TV18 that the rise of NDM-linked pathogens marks a “new chapter” in global antibiotic resistance—shifting from rare, overseas-linked cases to widespread domestic threats.

For U.S. health systems, the challenge lies not just in treating patients but also in preventing the bacteria from spreading further in hospitals and communities.

Bottom line

The surge of “nightmare bacteria” infections underscores the growing crisis of antibiotic resistance. With limited treatment options, prevention, early diagnosis, and strict infection-control measures are critical. Health officials say addressing the threat will require global cooperation, investment in new antibiotics, and public awareness.