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 must begin treatment before laboratory results identify the causative organism, making empiric therapy vulnerable to antimicrobial resistance. Drug-resistant Neisseria gonorrhoeae illustrates the challenge: it has developed resistance to nearly every antibiotic previously used against it, leaving few effective treatment options.

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

Together, the 19 ranked pathogens 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 pathogens: Candida auris (C. auris), carbapenem-resistant Acinetobacter, carbapenem-resistant Enterobacterales (CRE), and drug-resistant N. gonorrhoeae. Three of the four have limited treatment options. CRE infections may force providers onto less effective drugs. Drug-resistant gonorrhea has developed resistance to nearly all antibiotics previously used to treat it, leaving few effective options. 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 sole recommended treatment for gonorrhea, showed reduced susceptibility in just 0.1% of isolates in 2023. Yet resistance or elevated minimum inhibitory concentrations to at least one of six monitored antibiotics rose to 55.4%, up from 47.8% in 2022. Much of that increase reflected growing resistance to tetracycline, penicillin, and ciprofloxacin, drugs no longer recommended for gonorrhea treatment. Macrolide-resistant pertussis remained rare: only two US cases were identified during 2024-2025, the first reported since 2018.

Many bacterial threats can share resistance genes across species, accelerating the spread of antimicrobial resistance. 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 closely tracking whether the rise in gonorrhea resistance observed in 2023 represents a short-term fluctuation or the beginning of a sustained trend. The agency is also encouraging 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