WASHINGTON — Drug-resistant germs are causing millions of infections and tens of thousands of deaths across the United States each year, threatening the effectiveness of treatments that help make surgery, cancer care and organ transplants possible, according to a new federal assessment.

The Centers for Disease Control and Prevention estimates that more than 9.3 million drug-resistant infections occur annually, resulting in more than 39,000 deaths. When Clostridioides difficile, commonly called C. diff, is included, the combined burden reaches approximately 9.7 million infections and 50,800 deaths, according to the CDC’s updated overview of antimicrobial resistance.

The agency’s 2026 Antimicrobial Resistance Threats Report identifies 19 bacterial and fungal threats, along with six additional pathogens on a watch list. The findings underscore the need to prevent infections, preserve effective medications and develop treatments for organisms that increasingly evade existing drugs.

What the CDC’s infection and death estimates mean

The distinction between the report’s two headline totals matters.

C. diff infections are not typically drug-resistant. The CDC includes the bacterium because antibiotic use and the spread of germs contribute both to C. diff infections and to antimicrobial resistance. Counting it alongside resistant pathogens provides a broader picture of these related public health threats, but describing all 9.7 million infections as drug-resistant would be inaccurate.

The agency aggregated 2023 estimates for the 19 threats to calculate the report’s overall burden. Those figures describe the annual scale of the problem, rather than infections counted so far in 2026, according to the report’s explanation of its estimates.

The CDC also changed its data sources and methods. Its methodology guidance explicitly cautions against directly comparing the new estimates with earlier reports for any pathogen except Candida auris.

That means the larger headline total cannot, by itself, establish how much resistant infections have increased since the previous assessment. Individual surveillance trends provide a more reliable way to examine changes where comparable data exist.

How drug-resistant germs threaten medical care

Antimicrobial resistance develops when bacteria or fungi acquire the ability to survive medications intended to kill them. The germs become resistant, rather than the patient’s body.

Resistance can narrow treatment options without eliminating every effective medication. Some infections nevertheless become extremely difficult, or impossible, to treat, the CDC explains.

The consequences extend beyond treating an isolated infection. Effective antimicrobial drugs help clinicians protect patients undergoing chemotherapy, organ transplantation, joint replacement and other procedures.

In an Oct. 27 statement responding to the report, Dr. Wendy Armstrong, president of the Infectious Diseases Society of America, warned that resistant infections prolong hospital stays, increase costs and make essential medical care harder to provide safely.

Four threats require urgent action

The CDC places four pathogens or pathogen groups in its urgent threat category: Candida auris, carbapenem-resistant Acinetobacter, carbapenem-resistant Enterobacterales and drug-resistant Neisseria gonorrhoeae, the bacterium that causes gonorrhea.

Another 13 threats are classified as serious and two as concerning. The categories account for factors including clinical harm, transmission, economic impact, prevention options and the availability of effective treatments.

Drug-resistant Neisseria meningitidis, which can cause meningococcal disease, appears among the serious threats. The separate watch list includes drug-resistant dermatophytes, Haemophilus influenzae and nontuberculous mycobacteria. Watch-list placement identifies potential threats whose full U.S. burden is not yet understood.

Candida auris continues to spread in health care facilities

Among the most concerning trends is the spread of Candida auris, a fungus that can cause severe infections, including bloodstream infections, particularly in patients with serious underlying conditions who require complex care.

The CDC’s pathogen-specific assessment reports that clinical cases increased by more than 50% in 2023 compared with the previous year. A separate CDC surveillance update lists 6,304 reported clinical cases in 2024.

The fungus can spread through health care environments, including contaminated surfaces and equipment. People can carry it without symptoms and still contribute to transmission, making screening and infection control important even when a patient does not appear ill.

Resistance patterns also require careful interpretation. In 2023, 96% of tested samples were resistant to fluconazole, but resistance to echinocandins, the recommended first-line treatment, was identified in 1% of samples. Resistance to all three major antifungal classes has been detected but remains rare.

Those differences matter because widespread resistance to one medication does not mean every infection is untreatable. The CDC emphasizes early detection, hand hygiene, appropriate protective equipment and effective disinfectants to prevent spread.

Hospitals remain central to prevention efforts

Patients in hospitals and nursing homes can face heightened risks because serious illnesses, invasive devices and intensive treatment may increase their vulnerability to infection.

According to the CDC’s assessment of resistance in health care, seven bacterial threats commonly associated with medical care caused more than 42,000 deaths and nearly $12 billion in health care costs in 2023. That grouping includes C. diff and should not be interpreted as a count exclusively of drug-resistant infections or infections acquired inside hospitals.

The pandemic also disrupted earlier progress. The CDC reports that six drug-resistant bacterial hospital-onset infections increased by a combined 20% during the COVID-19 pandemic compared with the prepandemic period, peaking in 2021 and remaining above prepandemic levels in 2022.

Preventing infections associated with surgery and medical devices, improving antibiotic use and controlling transmission between facilities remain central to the response. Patients can carry resistant organisms when they move between hospitals, nursing facilities and their homes.

Resistance does not mean every treatment has failed

Carbapenem-resistant Enterobacterales, known as CRE, illustrate the challenge posed by resistance to powerful antibiotics.

Enterobacterales include bacteria such as E. coli and Klebsiella. Some normally live in the intestines without causing illness but can cause serious infections when they enter other parts of the body.

The CDC’s CRE assessment identifies patients with ventilators or catheters, as well as those receiving prolonged courses of certain antibiotics, as potentially facing greater risk. Treatment options for CRE infections are limited.

Drug-resistant gonorrhea presents a different problem, extending the report’s concerns beyond hospitals. The bacterium has developed resistance to many antibiotics used against it, leaving relatively few effective options. The CDC’s gonorrhea assessment emphasizes access to successful treatment as essential to limiting transmission and further resistance.

Antibiotic prescribing is part of the response

Antibiotics remain lifesaving medications, but their use can also create opportunities for resistance and other complications.

C. diff demonstrates the connection. Antibiotics can disrupt helpful microorganisms in the gut, increasing susceptibility to infection. The CDC’s C. diff assessment identifies current or recent antibiotic use as a risk factor and notes that severe cases can lead to serious intestinal complications, sepsis or death.

Antimicrobial stewardship programs seek to improve prescribing so patients receive appropriate treatment while reducing unnecessary exposure.

Technology is one part of that effort. USA Herald previously reported on BioMérieux’s acquisition of clinical software company Lumed, whose tools support prescribing guidelines, antimicrobial stewardship and infection control.

Armstrong’s statement also urged Congress to pass the PASTEUR Act to encourage development of new antimicrobial drugs and support stewardship programs. The appeal reflects the need both to expand treatment options and to protect the effectiveness of medications already available.

What patients can do to reduce their risk

The CDC recommends practical prevention measures, including washing hands, keeping wounds clean and covered, staying current on recommended vaccinations and managing chronic conditions.

Patients can ask health care professionals about infection risks, treatment choices and whether antibiotics or antifungals are appropriate for their illness.

Preventing infections reduces the need for medication in the first place. When treatment is necessary, appropriate prescribing and infection control work together to protect the patient and limit the spread of resistance.