Antibiotics have long been used to treat common bacterial infections from strep throat to pneumonia.

But some germs develop the ability to survive the medications designed to kill them, and they’re an increasing risk to public health, the Centers for Disease Control and Prevention (CDC) warned.

In a report published Tuesday, the federal health agency said drug-resistant germs are a “growing threat to Americans.”

Drug-resistant germs, including bacteria and fungi, cause an estimated 9.7 million infections and 50,800 deaths each year in the U.S., the CDC’s report said.

“Antimicrobial resistance threatens modern medicine and puts millions of Americans at risk every year,” Dr. Erica Schwartz, director of the CDC, said in a press release on Tuesday. 

Which germs pose the greatest risk

The CDC classifies drug-resistant germs into three threat levels: “urgent,” “serious” and “concerning.”

Four germs fall into the “urgent” category, the agency’s highest level of concern. 

The first is Candida auris, a fungus that can cause anything from mild skin infections to severe, and potentially life-threatening, bloodstream infections. 

Reported C. auris cases jumped more than 50% from 2022 to 2023, according to the CDC.

The fungus primarily affects patients in hospitals and nursing homes who are already seriously ill, and can spread through medical equipment such as breathing tubes or catheters. 

People can also carry the fungus on their skin without getting sick and spread it to surfaces and objects around them.

The second is Neisseria gonorrhoeae, a sexually transmitted infection known as gonorrhea. 

The CDC estimates there were about 787,000 drug-resistant gonorrhea infections in 2023. When left untreated, gonorrhea can lead to pelvic inflammatory disease and infertility.

“And now we’re at the point where our probably broadest antibiotic class — called carbapenems — some of the bacteria are resistant to,” Daily said. 

The remaining two urgent threats are carbapenem-resistant Enterobacterales and carbapenem-resistant Acinetobacter, which can cause severe infections and are resistant to some of the strongest antibiotics available.  

Carbapenem-resistant Enterobacterales are gut bacteria, including E. coli, that caused an estimated 14,878 infections in hospitalized patients and 1,252 deaths in 2023.

For patients, this resistance can mean fewer effective treatment options, longer hospital stays and an increased risk of life-threatening complications.

Infections the CDC is monitoring 

Drug-resistant Neisseria meningitidis, also known as meningococcus, has been newly classified as a serious threat due to its ability to cause meningitis and bloodstream infections.

Unlike many of the germs listed in the CDC’s report, which mostly spread in hospitals and nursing homes, meningococcus spreads in everyday settings through close contact, such as kissing, sharing drinks or living in close quarters like college dorms. 

The CDC says this reflects a rise in drug-resistant infections in the community.

The CDC is also tracking six germs on a watch list, and their full impact isn’t yet known. One example is drug-resistant ringworm, a common fungal skin infection that is becoming harder to treat with standard fungal medications. 

The CDC says misusing over-the-counter antifungal creams and using steroid-antifungal cream combinations may contribute to resistance. 

Daily explained that as bacteria develop resistance, scientists must continue finding ways to make antibiotics effective.

“Since the ’40s, it’s been this arms race, starting with penicillin,” Daily said. “Some bacteria become resistant. Then we modify the antibiotic, so then it can kill the pathogen.”

Why drug resistance matters 

Antimicrobial resistance occurs when bacteria and fungi learn to outsmart the drugs used to treat them, leaving healthcare providers with fewer treatment options. 

“The bacteria are exposed to an antibiotic; they randomly develop mutations. Some are lucky enough to have a mutation that allows them to withstand that antibiotic,” Daily said.

Patients with weakened immune systems or serious underlying conditions, as well as those with medical devices, such as catheters, face especially high risks. 

“People go to the hospital to get better, and sometimes they may acquire from the hospital environment a more resistant bacteria than they came in with,” Daily said.

Infections commonly picked up in hospitals and other healthcare settings accounted for nearly $12 billion in healthcare costs in 2023, the report found. 

Prevention efforts work 

C. diff, a gut infection that causes severe diarrhea and is often triggered by antibiotic use, was downgraded from an urgent threat to a serious threat, the report said.

Infection rates fell 21% between 2018 and 2020 and rates have remained stable since.

Still, C. diff caused an estimated 412,504 infections in 2023, and adults aged 65 and older are infected at 4.5 to five times the rate of younger people. 

“This data shows both the progress we’ve made and the significant work that remains. High-quality data help drive action, and CDC is committed to providing easily accessible information to help protect people from drug-resistant infections,” Schwartz said in the press release. 

The CDC says the drop in C. diff shows that infection prevention and more careful antibiotic use can make a difference.

What people can do to protect themselves 

Antibiotics should only be used when prescribed by a healthcare professional. They do not work against viruses including those that cause the cold and flu, according to the CDC.

Washing hands regularly, staying up to date on recommended vaccinations and taking steps to prevent the spread of infections can also help.

“I always say to my patients, feel free to ask questions if you’re sick or you have an infection in your family,” Daily said. “Absolutely feel free to talk to the doctor.”

Dr. Tara Howard is a fourth-year dermatology resident and a member of the ABC News Medical Unit.

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