2019 AR Threats Report
CDC’s Antibiotic Resistance Threats in the United States, 2019 [PDF – 150 pages] (2019 AR Threats Report) includes the latest national death and infection estimates for 18 antimicrobial-resistant bacteria and fungi. This report underscores the continued threat of antimicrobial resistance in the U.S., the actions taken to combat this threat, and gaps slowing progress.
The germs are listed in three categories—urgent, serious, and concerning—based on level of concern to human health. The report also includes a Watch List with three threats that have not spread widely in the U.S. but could become common without continued aggressive action.
The 2019 AR Threats Report is intended to:
- Serve as a reference for information on antimicrobial resistance
- Provide the latest U.S. antimicrobial resistance burden estimates for human health
- Highlight emerging areas of concern and additional action needed
The 2019 report also emphasizes progress in combating antimicrobial resistance. However, CDC’s 2022 special report highlighting the impact of COVID-19 on antimicrobial resistance in the U.S. found that much of that progress was lost, in large part, due to the effects of the pandemic. The pandemic pushed healthcare facilities, health departments, and communities near their breaking points in 2020, making it very hard to maintain the progress in combating antimicrobial resistance.
In 2013, CDC published the first AR Threats Report, which sounded the alarm to the danger of antimicrobial resistance. The 2013 and 2019 reports do not include viruses (e.g., HIV, influenza) or parasites. The 2013 report stated that each year in the U.S. at least 2 million people got an antimicrobial-resistant infection, and at least 23,000 people died. The 2013 AR Threats Report helped inform the first National Action Plan for Combating Antibiotic-Resistant Bacteria. Learn how CDC is taking action to combat this threat.
More than 2.8 million antimicrobial-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result. When Clostridioides difficile—a bacterium that is not typically resistant but can cause deadly diarrhea and is associated with antibiotic use—is added to these, the U.S. toll of all the threats in the report exceeds 3 million infections and 48,000 deaths.
Download the 2019 AR Threats Report [PDF – 150 pages] to learn more.
Bacteria and Fungi Listed in the 2019 AR Threats Report
- Drug-resistant Campylobacter
- Drug-resistant Candida
- ESBL-producing Enterobacterales
- Vancomycin-resistant Enterococci (VRE)
- Multidrug-resistant Pseudomonas aeruginosa
- Drug-resistant nontyphoidal Salmonella
- Drug-resistant Salmonella serotype Typhi
- Drug-resistant Shigella
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Drug-resistant Streptococcus pneumoniae
- Drug-resistant Tuberculosis
Acinetobacter bacteria causes pneumonia and wound, bloodstream, and urinary tract infections. Nearly all infections happen in patients who recently received care in a healthcare facility.
- 8,500 estimated cases in hospitalized patients in 2017
- 700 estimated deaths in 2017
Drug-resistant Candida auris
C. auris is an emerging multidrug-resistant yeast (fungi). It can cause severe infections and spreads easily between hospitalized patients and nursing home residents.
323 clinical cases in 2018
C. difficile, or C. diff, bacteria causes life-threatening diarrhea and colitis (an inflammation of the colon), mostly in people who have had both recent medical care and antibiotics.
- 223,900 infections per year
- 12,800 deaths per year
Carbapenem-resistant Enterobacterales (CRE)
CRE bacteria are a major concern for patients in healthcare facilities. Some Enterobacterales are resistant to nearly all antibiotics, leaving more toxic or less effective treatment options.
- 1,100 estimated deaths in 2017
- 13,100 estimated cases in hospitalized patients in 2017
Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. It is a sexually transmitted disease that can result in life-threatening ectopic pregnancy and infertility, and can increase the risk of getting and giving HIV.
- 550,000 estimated drug-resistant infections per year
About CDC’s Serious Threats
Campylobacter bacteria usually causes diarrhea (often bloody), fever, and abdominal cramps. It can spread from animals to people through contaminated food, especially raw or undercooked chicken.
- 448,400 drug-resistance infections per year
- 70 estimated deaths per year
Drug-resistant Candida Species
Dozens of Candida species—a group of fungi—cause infections, ranging from mild oral and vaginal yeast infections to severe invasive infections. Many are resistant to the antifungals used to treat them.
- 34,800 estimated cases in hospitalized patents in 2017
- 1,700 deaths in 2017
ESBL-producing Enterobacterales are a concern in healthcare settings and the community. They can spread rapidly and cause or complicate infections in healthy people. ESBLs (extended-spectrum beta-lactamase) are enzymes that make commonly used antibiotics ineffective
- 197,400 estimated cases in hospitalized patients in 2017
- 9,100 estimated deaths in 2017
Vancomycin-resistant Enterococcus (VRE)
Enterococci bacteria can cause serious infections for patients in healthcare settings, including bloodstream, surgical site, and urinary tract infections.
- 54,500 estimated cases in hospitalized patients in 2017
- 5,400 estimated deaths in 2017
Multidrug-resistant Pseudomonas aeruginosa
P. aeruginosa bacteria usually cause infections in people with weakened immune systems. It can be particularly dangerous for patients with chronic lung diseases.
- 32,600 estimated cases in hospitalized patients in 2017
- 2,700 estimated deaths in 2017
Drug-resistant nontyphoidal Salmonella
Nontyphoidal Salmonella bacteria can spread from animals to people through food. It usually causes diarrhea, fever, and abdominal cramps. Some infections spread to the blood and can have life-threatening complications.
- 212,500 estimated drug-resistant infections per year
- 70 estimated deaths per year
Drug-resistant Salmonella serotype Typhi
Salmonella Typhi (also called Typhoid Fever) is bacteria that causes a serious disease called typhoid fever, which can be life-threatening. Most people in the U.S. become infected while traveling to countries where the disease is common.
- 4,100 estimated drug-resistant infections per year
- Less than 5 estimated deaths per year
Shigella bacteria spreads in feces through direct contact or through contaminated surfaces, food, or water. Most people with Shigella infections develop diarrhea, fever, and stomach cramps.
- 77,000 estimated drug-resistant infections per year
- Less than 5 estimated deaths per year
Methicillin-resistant Staphylococcus aureus (MRSA)
S. aureus are common bacteria that spread in healthcare facilities and the community. MRSA can cause difficult-to-treat staph infections because of resistance to some antibiotics.
- 323,700 estimated cases in hospitalized patients in 2017
- 10,600 estimated deaths in 2017
Drug-resistant Streptococcus pneumoniae
S. pneumoniae bacteria causes pneumococcal disease (also called pneumococcus), which can range from ear and sinus infections to pneumonia and bloodstream infections.
- 900,000 estimated infections in 2014
- 3,600 estimated deaths in 2014
Tuberculosis (TB) is caused by the bacteria Mycobacterium tuberculosis. It is a common infectious disease that frequently causes death worldwide.TB can be resistant to more than one antibiotic used to treat it.
- 847 Drug-resistant TB cases in 2017
- 62 Deaths in 2017
About CDC’s Concerning Threats
Erythromycin-resistant Group A Streptococcus (GAS)
GAS bacteria can cause many different infections that range from minor illnesses to serious and deadly diseases, including strep throat, pneumonia, flesh-eating infections, and sepsis.
- 5,400 estimated drug-resistant infections in 2017
- 450 estimated deaths in 2017
Clindamycin-resistant Group B Streptococcus (GBS)
GBS bacteria can cause severe illness in people of all ages.
- 13,000 estimated drug-resistant infections in 2016
- 720 estimated deaths in 2016
CDC’s Watch List
Azole-resistant Aspergillus fumigatus
Aspergillus is a fungus that can cause life-threatening infections in people with weakened immune systems. These infections are treated with antifungals called azoles. Azoles are also increasingly used in agriculture to prevent and treat fungal diseases in crops. Azole use in human medicine and agriculture can contribute to resistance to antifungal medicines.
Drug-resistant Mycoplasma genitalium (M. genitalium)
M. genitalium bacteria are sexually transmitted and can cause urethritis in men (inflammation of the urethra) and may cause cervicitis in women (inflammation of the cervix). Few antibiotics are available to treat M. genitalium infections. Resistance to azithromycin, which has been recommended for treatment, is high across the globe.
Drug-resistant Bordetella pertussis (B. pertussis)
Pertussis, a respiratory illness commonly known as whooping cough, is a very contagious disease caused by bacteria. It can cause serious and sometimes deadly complications, especially in babies.