'These creatures are really evil': Nightmare bacteria live up to their nickname

Michael Schmidt, Ph.D., a microbiologist at the Medical University of South Carolina, used a phrase that could come from a horror movie to describe what the Centers for Disease Control and Prevention calls nightmare bacteria. “These creatures are really evil,” he said.

The creatures, bacteria with the NDM gene, make an enzyme that protects them against most antibiotics. (NDM stands for New Delhi metallo-beta-lactamase.) The full name is NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE). 

That’s a mouthful, but it’s worth knowing. That’s because the CDC has released a report saying infections from NDM-CRE rose more than 460% from 2019 to 2023. It’s calling for health care providers to be on the lookout, test promptly for NDM-CRE infections, carefully select which antibiotics to use and work to prevent infections in health care settings.

Schmidt said antibiotic-resistant bacteria can be dangerous. “They can cause everything from pneumonia to bloodstream infections, which your mother would know as sepsis or blood infection, to wound infections, to even life-ending urinary tract infections.”

 

They’re not only challenging to treat but also have the potential to spread quickly. In its news release, a CDC epidemiologist called NDM-CRE “a growing threat that limits our ability to treat some of the most serious bacterial infections.” 

So how did we get here? The CDC cites “gaps in infection control” involving measures such as hand washing, proper cleaning and disinfecting in health care settings. It also mentions a lack of ability in many hospitals and clinics to rapidly test for NDM-CRE infections. 

MUSC Health does have the ability to do that testing and sends its results to the South Carolina Department of Public Health. It works closely with the state to monitor the situation and ensure that its clinical teams learn how to protect their patients from dangerous microbes.

Schmidt, a professor in the College of Medicine specializing in hospital-acquired infections, disaster preparedness and bacterial pathogenesis, offered a couple of other factors to consider.

First, he cited the use of antimicrobials in food-producing animals. Antimicrobials is an umbrella term that includes the smaller category of antibiotics, which kill germs and prevent their growth.

“Antimicrobials are in some of the animals’ diets. It's to make them more efficient at converting food into biomass. It isn’t to treat illness. It’s to prevent it.” A healthy animal is less expensive than a sick one and moves faster from farm-to-table.But antimicrobial overuse can lead to antibiotic resistance that’s passed on to humans through the food chain, Schmidt said.

There are steps the public can take to try to prevent that transmission. “Cook your food to the right temperatures. This is why we have public health requirements that hamburgers be cooked to medium well. The inside gets hot enough to kill the microbes. It's why we don't eat cookie dough unless the eggs are pasteurized. So even though cookie dough tastes delicious, unless you pasteurize the eggs, don't do that.”

His second additional potential factor in the rise of NDM-CRE infections: the overuse of antibiotics in people.“You don't need an antibiotic for every infection, because most infections are viral. You don't need an antibiotic for a cold, for example. That’s why MUSC and many health systems are focusing on antibiotic stewardship.”

They don’t want to ruin a good thing, he said. “The penicillin class of antibiotics is so effective at stopping infections. That’s why they were the miracle when they became available. Because you only needed a little bit, and you generally start feeling better the next day. And that still is the case, but please take the full course of the prescription. By doing so, you will help control the spread of antibiotic resistance.”

When they lose that power against germs, the scenario becomes nightmarish, in the CDC’s words. “That's why they're changing the narrative. To try to preserve the utility of our anti-microbials. Because if everybody's resistant, they're no good,” Schmidt said.