Misuse of antibiotics has been a major driver of resistance—both in strain-specific bacteria and gene-based resistance. "Prudent antibiotic use should always be the goal," Limbago says. But "once the gene is there, it's there. And at that point, the genie's out of the bottle."
After resistance has started circulating, surveillance and infection control become the key tools to fight further spread. The U.S. does not have KPC- or NDM-1–specific strategies, but offers recommendations for all CRE-positive infections. The government also does not require hospitals to report CRE cases, but even so, infections have been confirmed in at least 35 states. Rather than being cautious about the growing concern over NDM-1 and other resistance genes, Limbago suggests that, "in some places in the U.S. people are not getting as excited about this as they should."