NDM-CRE Surge Demands Stronger Infection Prevention and Testing Strategies, Study's Author Says

In the second part of our conversation with Danielle Rankin, PhD, MPH, CIC, epidemiologist with the CDC, she expanded on the infection prevention strategies and surveillance needs surrounding the rise of New Delhi metallo-β-lactamase carbapenem-resistant Enterobacterales (NDM-CRE). She is the lead author of a recent study published in the Annals of Internal Medicine.

Rankin emphasized that early infection control measures are critical when a case is detected. “It’s really important that IPs work with their state and local health care-associated infections and antimicrobial resistance programs to prevent spread,” she said. Patients hospitalized with NDM-CRE should be placed on contact precautions, while long-term care residents require enhanced barrier precautions. She also underscored the basics: “Reinforce the importance of hand hygiene…before touching a patient, before performing an aseptic task, after contact with bodily fluids, and, of course, after glove removal.”

Environmental hygiene remains equally vital. High-touch surfaces, such as bed rails, call buttons, and light switches, should be disinfected regularly. Additionally, shared equipment like portable X-ray machines must be cleaned thoroughly between patients. “You also want to make sure that staff are not pouring patient waste down sink drains,” Rankin cautioned, citing sinks as a known environmental reservoir.

Hand hygiene options prompted a practical discussion. “Hand sanitizer should be used and can be used in all instances except if a provider’s hands are contaminated from blood or bodily fluids—then they need to actually perform hand washing,” Rankin explained.

Beyond daily practices, Rankin highlighted the importance of timely surveillance and mechanism-specific testing. “The primary need is to really obtain prompt mechanism testing for CRE so this information can be used for treatment selection,” she said. Yet she acknowledged barriers, including the lack of guaranteed reimbursement for clinical laboratories. Expanding testing capacity while maintaining strong public health laboratory support is essential for rapid response.

Her message for infection preventionists and epidemiologists was clear: “Historically, the most common carbapenemase was KPC [Klebsiella pneumoniae carbapenemase], but now we’re seeing this surge of NDM-CRE in the United States, which really threatens to reverse years of stable or declining CRE rates.” With only 2 approved beta-lactam drugs effective against NDM-CRE, Rankin urged facilities to integrate mechanism testing into their workflows and use the CDC’s AR Lab Network when local resources are unavailable.

“Infection control interventions must be timely,” Rankin concluded, “to ensure patients receive appropriate therapy and facilities can prevent further spread.”

Read Rankin and her colleagues’ study published in the Annals of Internal Medicine here.

Find the first installment of the interview here.

Enterobacterales bacterium

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