CDC ranks drug resistance threats, four of them urgent

Clinical takeaway: Watch for resistance to the drugs clinicians reach for first: ceftriaxone for gonorrhea, macrolides for pertussis, and echinocandins for C. auris. This remains rare, though echinocandin resistance is increasing.

Clinicians often start treatment before the lab has identified an organism, so the first drug they pick is often the one that resistance can undercut. Gonorrhea is a prime example of how far that pathway can go: it has become resistant to nearly all the antibiotics used to treat it, and few options remain. 

This CDC report gives clinicians a national read on which resistant germs pose the most danger to patients, plus a Watch List of germs with the potential to become bigger problems. Its surveillance numbers show how large each one is. 

Together, the 19 ranked germs cause 9.7 million infections and 50,800 deaths a year in the US. Four are urgent, 13 serious, and two concerning. Infections commonly associated with health care accounted for more than 42,000 deaths and almost $12 billion in costs in 2023. Clostridioides difficile (C. diff), which is not typically drug-resistant, moved from urgent to serious after estimated cases fell an unadjusted 21% between 2018 and 2020. CDC cautions that changes in testing may have contributed. 

The urgent tier holds four germs: Candida auris (C. auris), carbapenem-resistant Acinetobacter, carbapenem-resistant Enterobacterales (CRE), and drug-resistant Neisseria gonorrhoeae. Three of the four leave clinicians little to work with. CRE infections may force providers onto less effective drugs. Gonorrhea now resists nearly all the antibiotics used against it. C. auris often defeats antifungals, and some infections can’t be treated at all. An estimated 1,252 people hospitalized with CRE died of the infection in 2023, and gonorrhea accounted for an estimated 787,000 drug-resistant infections. 

Ceftriaxone, the drug now advised for gonorrhea, showed reduced susceptibility in 0.1% of infections in 2023. Resistance to at least one of six antibiotics, elevated readings included, rose to 55.4% from 47.8% in 2022. The jump was driven in part by tetracycline, penicillin, and ciprofloxacin, none of which is still recommended for gonorrhea. Macrolide-resistant pertussis cases were few: two in the US across 2024 and 2025, the first since 2018. 

Most bacterial threats can pass resistance genes to unrelated bacteria. Incidence of CRE that produce the New Delhi metallo-β-lactamase (NDM) enzyme grew nearly fivefold from 2019 to 2023. Drug-resistant Neisseria meningitidis joined the serious list as resistant infections rose in community settings. In 2023, 1% of C. auris samples resisted echinocandins, the first-line treatment, and that number is increasing. Clinical C. auris cases have climbed just under tenfold since 2019. Resistance to all three antifungal classes has been detected but is rare. 

CRE estimates for hospitalized patients rely on the National Healthcare Safety Network, while NDM-CRE trends come from the Antimicrobial Resistance Laboratory Network. CDC changed its methods and data sources for this update, so it advises against comparing several of these figures with earlier reports. 

CDC is monitoring whether the 2023 jump in gonorrhea resistance was a one-year anomaly or the start of a trend. The agency also encourages clinical laboratories to expand testing that identifies which carbapenemase a CRE isolate carries, since treatment depends on it. On the Watch List are nontuberculous mycobacteria, azole-resistant Aspergillus fumigatus, and drug-resistant Bordetella pertussis, dermatophytes, Haemophilus influenzae, and Mycoplasma genitalium; their national burden isn’t yet understood. 

“Antibiotics are miracle drugs. They underpin most modern medicine,” says Christian Lillis, co-founder and executive director of the Peggy Lillis Foundation, a C. diff education and advocacy group. “To avoid unnecessary infections and prolong these drugs’ effectiveness, we must first see both the potential harms, as well as benefits, of antibiotics.” 

Source: Centers for Disease Control and Prevention (2026 Oct 27) CDC Antimicrobial Resistance Threats: Pathogens Impacting People in Health Care and in Communities