PASTEUR Act, NDM-CRE Surge, and the Cost of Inaction: What Infection Preventionists Need to Know About Antibiotic Policy and AMR

As antimicrobial resistance accelerates and the pipeline for new antibiotics continues to shrink, infection preventionists are increasingly being asked to manage complex, high-risk pathogens with limited tools. In this Q&A, Infection Control Today^® (ICT^®) speaks with Emily Wheeler, vice president of infectious disease policy at the Biotechnology Innovation Organization (BIO), about the urgent need for policy solutions such as the PASTEUR Act (Pioneering Antimicrobial Subscriptions to End Upsurging Resistance Act).

Wheeler outlines how the proposed subscription-based model could stabilize antibiotic development while reinforcing antimicrobial stewardship across health care settings. She also addresses the growing clinical and financial consequences of inaction, including the rapid rise of organisms such as New Delhi Metallo-β-lactamase–producing Carbapenem-Resistant Enterobacterales (NDM-CRE), which have surged dramatically in recent years.

From the burden on infection prevention programs to the broader implications for cancer care, surgery, and outbreak response, this discussion highlights a critical question facing the field: Can the health care system keep pace with evolving resistance threats without stronger federal support and innovation?

ICT: If the PASTEUR Act stabilizes the antibiotic development market, how should health systems prepare financially and operationally to integrate these novel agents responsibly?

Emily Wheeler: The PASTEUR Act (Pioneering Antimicrobial Subscriptions To End Upsurging Resistance Act) would stabilize the broken antibiotic marketplace by establishing a subscription-style model in which the federal government enters into a financial contract with developers of high-priority antimicrobials, ensuring treatment access for patients who need them while providing companies with predictable returns to sustain research and development. To integrate these novel antimicrobials responsibly, health systems should treat them as a critical additional tool in the armamentarium, reserved for the most serious drug-resistant infections, and put measures in place to ensure these novel medicines are used appropriately: for the right bug, at the right time, and for the right duration.

Antimicrobial stewardship programs play a critical role here, as they improve patient outcomes, reduce inappropriate use, and create savings to health systems. To support these important efforts, the PASTEUR Act would fund antimicrobial stewardship programs in rural, critical access, tribal, and safety-net facilities, helping ensure appropriate antimicrobial use while preserving their effectiveness for the future.

The PASTEUR Act of 2026 also establishes a new pilot program to test and evaluate antimicrobial stewardship programs in outpatient facilities, particularly urgent care and retail clinics, to improve stewardship outside the hospital as well.

ICT: What is the cost of inaction for health systems if the antibiotic pipeline continues to collapse, both in outbreak response and routine care?

EW: Antimicrobial resistance (AMR) is already turning once-manageable infections into serious, high-risk events. According to the most recent global estimates, antibiotic resistance played a role in nearly 5 million deaths and directly caused 1.2 million deaths in 2019. When common antibiotics fail, it threatens not only infectious disease care but also cancer treatment, organ transplantation, maternal care, and routine surgeries that rely on effective antibiotics. For cancer care, the stakes are particularly high.

Roughly 2 million Americans are diagnosed with cancer each year, and antibiotics are not ancillary to their care; they are what make it possible. Both the disease and its treatment can weaken the immune system, leaving patients particularly vulnerable to infections. Effective antibiotics are essential to helping patients safely undergo and survive cancer treatment.

The impact is even more serious in public health emergencies, outbreaks, or crises, when many patients require ventilators or catheters, thereby increasing the risk of infection. Highly resistant organisms can force unit closures, delay procedures, extend hospital stays, and drive up costs. CDC data show infections caused by New Delhi Metallo-β-lactamase–producing Carbapenem-Resistant Enterobacterales (NDM-CRE), aka "nightmare bacteria," surged by more than 460% in the US between 2019 and 2023. Without a stable antibiotic pipeline, hospitals will face increasingly resistant pathogens with fewer effective tools. That means longer hospitalizations, higher mortality rates, and escalating financial strain.

There is also a financial cost of inaction. Research has found that treating patients for just 6 of the most dangerous superbugs costs the US health care system more than $4.6 billion in direct health care costs each year. Without a stable antibiotic pipeline, hospitals will face increasingly resistant pathogens with fewer effective tools. That means longer hospitalizations, higher mortality rates, and escalating financial strain.

ICT: If new antibiotics become available through models like PASTEUR, how can IPs collaborate with antimicrobial stewardship to ensure they remain true last-line therapies?

EW: When new antibiotics reach the market, hospitals must implement measures to ensure their appropriate use. Today, just a handful of antimicrobials in development target the World Health Organization's "critical priority" pathogens. Responsible use is essential because each time an antimicrobial is used, pathogens have a chance to develop resistance to it. Infection prevention and antimicrobial stewardship programs should work together to reinforce a culture of judicious use by embedding critical antimicrobial stewardship programs within hospitals.

ICT: Where are IPs currently feeling the greatest strain related to resistant organisms, such as staffing, data reporting, outbreak management, and how could federal policy meaningfully help?

EW: Limited resources and workforce shortages are straining infection prevention programs, limiting their ability to meet data reporting demands and manage the increasing complexity of outbreak response. Resistant organisms require more intensive surveillance, faster containment, and closer coordination with laboratories and public health authorities, all while resources are stretched thin.

Federal policy can help by standardizing surveillance infrastructure, funding robust infection prevention programs, and strengthening the antibiotic pipeline. The PASTEUR Act would support antimicrobial development while funding stewardship programs in under-resourced facilities, such as rural, critical-access, tribal, and safety-net hospitals.

ICT: What it boils down to, at the end, is: "Are we asking infection prevention programs to contain a superbug crisis with 1990s-era tools?"

EW: In too many cases, yes. Our current arsenal of antimicrobials cannot keep pace with the growing scale of the superbug crisis. Experts estimate that without swift action, antimicrobial resistance will contribute to the deaths of nearly 170 million people globally by 2050. To protect patients, our health care system, and our biodefenses, we must strengthen antimicrobial development and stewardship now, before AMR rewinds decades of medical progress.