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

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

About CDC’s Urgent Threats

Medical illustration of acinetobacter

Carbapenem-resistant Acinetobacter

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
Medical illustration of C. auris

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

Medical illustration of C. difficile

Clostridioides difficile

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
Medical illustration of CRE

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
Medical illustration of gonorrhea

Drug-resistant Gonorrhea

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

Medical illustration of campylobacter

Drug-resistant Campylobacter

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
Medical illustration of fluconazole-resistant Candida

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
Medical illustration of ESBL-producing Enterobacterales

ESBL-producing Enterobacterales

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
Medical illustration of Vancomycin-resistant Enterococcus (VRE)

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
Medical illustration of multidrug-resistant Pseudomonas aeruginosa

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
Medical illustration of ESBL-producing Enterobacterales

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
Medical illustration of Vancomycin-resistant Enterococcus (VRE)

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
Medical illustration of shigella

Drug-resistant Shigella

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
Medical illustration of methicillin-resistant Staphylococcus aureus (MRSA)

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
Medical illustration of Drug-resistant Streptococcus pneumoniae

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
Medical illustration of Drug-resistant Tuberculosis

Drug-resistant Tuberculosis

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

Medical illustration of erythromycin-resistant Group A Streptococcus

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
Medical illustration of clindamycin-resistant Group B Streptococcus

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

Medical illustration of Azole-resistant Aspergillus fumigatus

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.

Medical illustration of clindamycin-resistant Group B Streptococcus

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.

Medical illustration of drug-resistant B. pertussis

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.