Drug-Resistant Infections: Four Pathogens Rated Urgent Threats

Drug resistance is already linked to a substantial burden of illness in the United States: a new report estimates that resistant bacteria and fungi cause 9.7 million infections and more than 50,000 deaths each year. It names 19 pathogens as threats to human health, with four rated urgent. The figures describe a serious public health challenge, though they don’t mean that most healthy people face a high risk of these infections.

The report groups pathogens into urgent, serious and concerning categories, alongside a watch list. Its estimates suggest the problem deserves attention, but comparisons with earlier figures need care: the previous report, released in 2019, recorded 2.8 million confirmed infections, and the authors say data sources and methods have changed. Those totals therefore can’t be directly compared to determine how much infections have risen.

Four pathogens in the urgent category

The report defines urgent threats as requiring urgent and aggressive action. The four named pathogens differ in how they spread and who is most likely to be affected.

• Candida auris: This drug-resistant fungus most often spreads in health care settings, including hospitals and long-term care facilities, through contact with an infected person or a contaminated surface. Many healthy people can fight off infection, but people with weakened immune systems may develop life-threatening illness. Cases increased by more than 50% from 2022 to 2023, according to the report.
• Carbapenem-resistant Enterobacterales (CRE): This group of bacteria resists carbapenems, a class of broad-spectrum antibiotics. Resistant E. coli is one example. CRE infections are often acquired in medical settings and can spread through contaminated hands, feces, wounds or equipment.
• Carbapenem-resistant Acinetobacter: These bacteria can cause infections in many parts of the body and often spread through contaminated surfaces in health care settings. The report says nearly two-thirds of infections in 2023 were spread through the community, underscoring that transmission isn’t limited to hospitals.
• Drug-resistant Neisseria gonorrhoeae: This bacterium causes gonorrhea, a common sexually transmitted infection. Antibiotics treat gonorrhea, but resistant strains make treatment more difficult. Without treatment, gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy and infertility.

Other pathogens on the list

Thirteen pathogens fall into the serious category, which calls for prompt and sustained action. The group includes Clostridioides difficile (C. diff), drug-resistant Campylobacter, Candida, tuberculosis bacteria, Neisseria meningitidis, several types of Salmonella, Shigella, Streptococcus pneumoniae, extended-spectrum cephalosporin-resistant Enterobacterales, MRSA, multidrug-resistant Pseudomonas aeruginosa and vancomycin-resistant Enterococcus.

Two more appear in the concerning category, which calls for careful monitoring and prevention: clindamycin-resistant group B Streptococcus and drug-resistant group A Streptococcus. The breadth of the list reflects how resistance affects different kinds of infections, not a single disease with one route of transmission or one prevention approach.

Why resistance develops

Infectious disease specialist Thomas Russo, M.D., of the University at Buffalo, points to antibiotic overuse and misuse as major drivers. When antibiotics are used unnecessarily or incorrectly, bacteria that survive treatment can multiply and spread. Antibiotics also don’t treat viral illnesses such as colds, COVID-19 or flu, even when symptoms feel severe.

Patient expectations can contribute to unnecessary prescribing. In a 2024 study published in Healthcare, 81% of surveyed general practitioners said patients typically expect antibiotics for their symptoms. Russo says both clinicians and patients have a role in using these medicines judiciously.

Developing new drugs presents another challenge. Russo says pharmaceutical companies have devoted fewer resources to antimicrobial medicines, in part because these treatments generally aren’t taken for long periods. The report’s findings therefore point to two connected needs: preserving the effectiveness of existing medicines and finding ways to develop treatments for infections that resist them.

Who faces greater risk, and what can help

People in hospitals or long-term care are more exposed to some of the listed organisms. Amesh Adalja, M.D., of the Johns Hopkins Center for Health Security, says the highest-risk patients include those using ventilators, catheters or central lines, as well as people receiving chemotherapy or living with a transplant. Serious illness, weakened immunity and medical devices can all raise vulnerability to infection. For a healthy person, the risk from CRE, carbapenem-resistant Acinetobacter and C. auris is generally low without a connection to hospital or long-term care.

Other infections on the list can affect people outside medical facilities. Gonorrhea, foodborne infections from Salmonella or Campylobacter, Shigella and MRSA are among the examples Adalja highlights. Practical prevention depends on the organism, but several steps can reduce exposure or limit avoidable antibiotic use:

• Discuss whether antibiotics are needed when a clinician evaluates an illness. They don’t work against viruses.
• Stay current on pneumococcal and influenza vaccination, and get meningococcal vaccination when recommended. Preventing infections can also prevent some antibiotic use and secondary bacterial infections.
• Cook poultry and eggs thoroughly, and wash hands while preparing food.
• Use condoms and get tested for sexually transmitted infections. Gonorrhea is one of the urgent threats for which individuals can take practical steps to reduce risk.
• During a hospital stay, patients or family members can ask whether staff have cleaned their hands and whether a catheter or line is still needed.

Antibiotic resistance will continue to evolve, Adalja says; how quickly it outpaces available medicines depends in part on how these drugs are used. For patients, the useful takeaway is to ask questions about treatment, follow prevention advice suited to the infection and raise concerns with a clinician or pharmacist when a prescribed medicine or its purpose is unclear.