• A new CDC report found a sharp increase in infections caused by a dangerous “nightmare bacteria.”
• Carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) are bacteria capable of neutralizing powerful antibiotics.
• CP-CRE bacteria are very difficult to treat and potentially deadly, capable of causing pneumonia and bloodstream infections, among other symptoms.

A new CDC report shows that infections caused by multi-drug-resistant bacteria known colloquially as “nightmare bacteria” surged in the United States from 2019 to 2023.

Carbapenem-resistant Enterobacterales (CRE), which include bacteria such as E. coli and Klebsiella pneumoniae, are resistant to carbapenems, a “last line” class of broad-spectrum antibiotics used to treat severe infections, including those caused by other drug-resistant bacteria.

Within CRE exists an even more dangerous subset of bacteria known as carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE). These variants produce an enzyme called carbapenemase, which enables them to break down carbapenem antibiotics, neutralizing the drugs before they can work, leaving doctors with limited options for treatment.

The CDC report, published in Annals of Internal Medicine, identified a specific type of CP-CRE, known as New Delhi metallo-β-lactamase (NDM-CRE), as the major driver of new infections. NDM-CRE is resistant to newer antibiotics developed specifically for the treatment of carbapenem-resistant infections.

Between 2019 and 2023, CP-CRE clinical cultures reported by US surveillance networks in 29 different states — and representing more than one-third of the U.S. population — rose by 69%. Across that same timeframe, the incidence of NDM-CRE infections increased by 461%.

“This sharp rise is concerning as we face a growing threat that limits our ability to treat some of the most serious bacterial infections that patients can get,” Danielle A. Rankin, PhD, an epidemiologist at the CDC and first author of the report, told Healthline.

A separate CDC report estimated that CRE was responsible for 12,700 infections and 1,100 deaths in 2020.

In addition to being harder to treat due to the presence of the carbapenemase enzyme, NDM-CRE is also capable of spreading its genes to other bacteria, including different species, allowing them to rapidly acquire resistance. As more bacteria acquire resistance, the infection becomes more difficult to contain.

CP-CRE infection may spread in healthcare settings

Under normal circumstances, CP-CRE infection is unlikely for healthy individuals. Like other drug-resistant bacteria, CP-CRE spreads primarily in hospitals and other healthcare environments.

“This increase that we’re seeing is within patients in healthcare facilities. This is not in the community, this is among our sickest-of-sick patients,” Rankin said.

Individuals most at risk for CP-CRE infection are those who:

• require a ventilator to breathe
• use invasive medical devices, such as urinary or intravenous catheters
• are already taking long courses of antibiotics
• have weakened immune systems

CP-CRE can affect different systems in the body defending on the site of the infection, so it may present in a variety of different ways.

“There are no specific symptoms to CRE,” Rankin said. 

“It may impact the urinary tract, and therefore, we would see symptoms consistent with a urinary tract infection. You may see someone who has developed a respiratory tract infection, and the CRE could manifest as pneumonia.”

Other types of infections caused by CRE may include:

• bloodstream infections
• wound infections
• meningitis

CP-CRE is resistant to nearly all available antibiotics. Due to how difficult it is to treat, surveillance and prevention are important factors in mitigating the risks of this devastating infection.

“Detecting these infections early and quickly is imperative to prevent further complications, including mortality. This allows us to choose the appropriate antibiotic, which must be tailored to the carbapenemase type,” said Marnie L. Peterson, PharmD, PhD, outreach coordinator for Antimicrobial Stewardship with the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota. Peterson wasn’t involved in the CDC report.

“Limited antibiotic options mean a complicated decision for clinicians in customizing antibiotics to the patient’s specific conditions, such as renal and hepatic insufficiencies or allergies,” she added.

CRE is spread by direct contact between infected individuals, contaminated surfaces, and medical equipment. In rare cases, the CDC has documented transmission between animals and humans.

Both humans and animals can unknowingly carry CRE on their bodies without showing symptoms, passing it to others in a process known as colonization.

Preventing the spread of CRE in healthcare facilities relies on a multi-pronged approach that includes surveillance (i.e., identifying, reporting, and tracking), as well as hygiene and sanitization of surfaces and tools.

Regular handwashing is one of the most important things individuals can do to limit the spread.

Even otherwise healthy individuals should be meticulous with hand hygiene in hospitals and care facilities.

“Healthy individuals are part of this strengthened awareness and prevention strategy. They should be aware of the increasing risk of antibiotic resistance due to NDM-CRE and prevention, especially if they are caregivers to immunocompromised and elderly individuals,” Peterson said.

Antimicrobial resistance: The ‘silent pandemic’

Antimicrobial resistance (AMR) is a broad term that describes when different microbes (bacteria, viruses, fungi, and parasites) develop resistance to drugs designed to kill them.

This phenomenon is frequently called the “silent pandemic,” because it is a growing healthcare crisis with little public awareness.

Some of the most common antibiotic-resistant infections include methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae. Additionally, Clostridium difficile, or C. diff, is associated with AMR.

While C. diff itself is typically not a resistant bacterium, it causes infection by exploiting dysregulation of the gut microbiome caused by antibiotic usage.

In the United States, nearly 3 million antimicrobial-resistant infections occur each year, and that number is expected to continue growing. In 2019, nearly 5 million deaths were associated with AMR globally.

A systematic forecast published in The Lancet in 2024 estimated that 39 million people could die from antibiotic-resistant bacterial infections by 2050. In that year alone, an estimated 1.91 million people could die from bacterial AMR, an increase of nearly 70% per year compared to 2021.

To combat this “silent pandemic,” major public health organizations, including the CDC and WHO, have invested in antimicrobial stewardship — efforts aimed at improving antibiotic prescribing practices and reducing overuse.

“Antibiotic stewardship has progressed exponentially in the past five years due to the formation of interdisciplinary teams who have access to better testing and diagnostic tools, as well as improved research methodologies,” said Peterson.

• NBA star Jayson Tatum of the Boston Celtics opens up about rupturing his Achilles tendon during the Eastern Conference playoffs in May.
• The two-time Olympic gold medalist shares how me managed pain after his injury.
• Tatum discusses his appreciation for his family, his health, and his love for the game.

When Boston Celtics star and two-time Olympic gold medalist Jayson Tatum ruptured his Achilles tendon on May 12 during the NBA playoffs against the New York Knicks, he knew it was significant.

“Being a basketball player, we understand movements related to certain injuries. When I pushed off, I could hear it pop. It felt like somebody kicked me, but I knew nobody was behind me,” Tatum told Healthline. “So immediately when I heard it, I fell and I grabbed my calf and I knew what just happened.”

The next day, he underwent surgery to repair his Achilles tendon.

“When I had surgery, they gave me [an opioid for pain] at 8:00 p.m., and at midnight, then they woke me up again at 4:00 a.m., and I was so nauseous and I felt so sick and out of it. I told my trainer I would rather tough it out with the pain because the medicine that they gave me is making me feel worse,” Tatum said.

It had been 19 weeks since the injury when Healthline spoke with Tatum about his recovery and why he switched to a non-opioid medication for pain management. Here’s what we learned.

Non-opioid medication helped Tatum find relief

Tatum’s doctor, Martin J. O’Malley, MD, orthopedic surgeon at Hospital for Special Surgery (HSS), changed Tatum’s opioid medication to Journavx, a non-opioid pain medication.

While opioids relieve pain by interfering with nerve signals that transmit pain from the body to the brain, they also activate the brain’s reward system, releasing large amounts of the feel-good dopamine. Because of this, they carry the risk of addiction.

“[Journavx is] works differently by reducing signals before they reach the brain and are felt as pain,” O’Malley told Healthline. “[It] works in the peripheral nervous system and never reaches the brain, so it has no risk of addiction.”

However, he noted that everyone’s experience is different, and as with any medication, people could experience side effects, and should talk with their doctor about the safest pain relief options for them.

Tatum teamed up with the makers of Journavx to speak out about how it helped him through his injury.

“This recovery and the rehab process is a long one,” Tatum said.

“There’s just so many different phases. You have surgery, then two weeks later you get your stitches out, and then they put you in this boot for 10 weeks, and then at four weeks you get crutches and you’re introducing 50% weight bearing,” he said.

By that point, Tatum continued to experience some discomfort and talked with his doctor about it.

“He prescribed me non-opioid medication for moderate to severe acute pain and for me it really helped. It took the pain away,” said Tatum.

Because Tatum’s injury was so public, he said he hopes to connect with others by sharing his story.

“Obviously I’m not the only one in the world that’s dealt with an injury that causes pain, so I thought it was a perfect opportunity to be vulnerable, talk about what I’m dealing with, my process, and be a conversation starter for people and their doctors about different choices and options.”

Tatum leaned on fans’ support during his recovery

After his injury, Tatum had a hard time accepting he would miss a year of playing.

“I was in disbelief. I was sad. I wasn’t sure if I was up for what was all about to happen or be required for me to come back. I was like, I don’t know if I can do this,” he said. “It’s tough. You’re lying there, you got this splint on, and your foot is all wrapped up and elevated, and you can’t put pressure on it, and you’re just like, ‘How am I ever going to play basketball again?’ It’s just kind of hard to envision in that moment.”

He leaned on the support of his friends, mom, and two children, 7-year-old Deuce and 14-month-old Dylan.

“Even when they didn’t know they were uplifting my spirits; it’s like being around them and laughing and joking on some of those tough days, it was just helpful,” he said.

He also leaned on his fans’ support through social media.

“They were checking on me, praying for me, wishing me a speedy recovery. It really does go a long way and I’m very thankful for that,” Tatum said. “Obviously I love the game for my teammates, but just as importantly for the fans that appreciate what I bring to the game.”

Generally, the return to play for a professional athlete who ruptured their Achilles tendon is 9 to 12 months, said O’Malley.

“That means you’re back performing at the same level you did before. For a regular person, the recovery time is closer to 10 to 12 weeks to get back to normal activity — walk around wearing regular shoes, get to work without public transportation, etc. — and closer to 6 months to feel like you’re no longer injured,” he said.

Physical therapy is the most important part of recovery, he added.

“If a player works hard at their physical therapy post-operation, they will return to the same performance level as when they were injured,” said O’Malley. “Jayson has been a model patient. No one has outworked him in terms of his rehab.”

A new appreciation for health and basketball

As he moves on in his professional basketball career, Tatum said he values his health more than ever.

“When I first got to the NBA, I was 19. I didn’t value eating the right things or sleeping as much, or lifting or recovery as much as I do now,” Tatum said.

“As you get older and throughout your career, we play so many games. The season is so long. I’m only 27, so I’m still very young, but the more basketball I play, the more I value sleep and eating better. It’s about understanding that the investment you put into your health and your body will prolong your career.”

With each season, his appreciation for his ability to play grows.

“I never was a person that cheated the game. I never took shortcuts. I always tried to maximize the God-given ability that I had,” he said. “I love to play, I love the game, and so I always had a deep level of appreciation for the game of basketball, what it’s done for my life, what it’s done for my family, and it’s as high as it can be now.”

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• A new study found that nicotinamide (vitamin B3) use was linked to fewer cases of non-melanoma skin cancers.
• The supplement was tied to a 14% reduction in future skin cancers, with the greatest benefit in people who started taking it after their first diagnosis.
• The findings build on a small clinical trial that showed nicotinamide could lower the risk of new skin cancers.
• Experts say nicotinamide may be a helpful add-on, but sunscreen, protective clothing, and regular skin checks remain the best preventive measures.

A common vitamin supplement could play an even bigger role in skin cancer prevention than we once thought. 

A new study published on September 17 in JAMA Dermatology examined more than 33,000 U.S. veterans and found that people who took nicotinamide (a derivative of vitamin B3) had fewer cases of non-melanoma skin cancers than those who didn’t.

The researchers reported a 14% overall reduction in future skin cancers, including basal cell carcinoma and squamous cell carcinoma.

Meanwhile, the biggest benefit was seen in people who started taking nicotinamide after their first skin cancer diagnosis. Their risk of developing another dropped by more than half.

While the protective effect wasn’t as strong in people who began taking nicotinamide after multiple cancers, the findings add weight to growing evidence that this low-cost and widely available supplement may be a helpful tool in skin cancer prevention.

A clinical study published in 2015 with 386 participants showed that those who took the vitamin B3 derivative developed fewer new occurrences.

This larger study validates those earlier findings by examining real-world data from tens of thousands of patients, offering stronger evidence of nicotinamide’s protective effect against skin cancer. 

Nicotinamide and skin cancer prevention 

Hannah Kopelman, MD, dermatologist at Kopelman Aesthetic Surgery, told Healthline this research is “confirmatory evidence” that nicotinamide can reduce future keratinocyte skin cancers, especially squamous cell carcinoma, when started soon after a first cancer.

“This study builds on earlier randomized trials and makes me more comfortable recommending it to the right patients in my own practice,” she said. 

Kopelman explained why nicotinamide appears to have a protective mechanism when it comes to skin cancer. 

“Nicotinamide replenishes energy stores in the skin cells so they can repair DNA damage from UV exposure more efficiently,” she said. 

“It also helps preserve local immune surveillance in the skin, which UV light can suppress,” she added. 

“Together, these effects mean fewer UV-damaged cells are able to survive, accumulate mutations, and progress into skin cancers.” 

Anna Andrienko, a dermatologist and aesthetic doctor at Dr. Ducu Clinics, said nicotinamide is a precursor to NAD+, a cellular cofactor that’s involved in DNA repair and cellular energy metabolism. 

“UV radiation causes DNA damage and depletes cellular NAD+ and ATP reserves, but nicotinamide helps restore these energy stores and boosts the efficiency of DNA repair processes in UV-damaged skin cells,” she explained. 

“It also has anti-inflammatory effects, which can reduce the pro-tumour environment created by chronic UV injury.” 

Together, Andrienko said these actions make nicotinamide “biologically plausible as a chemopreventive agent for UV-related skin cancers.” 

More research on nicotinamide and skin cancer needed

While the new study’s findings show promise for the protective effects of nicotinamide against certain types of skin cancer, there are a few important caveats. 

“This was a retrospective study, Kopelman noted. “This means there are confounding factors we can’t completely control, like sun habits, adherence, and the intensity of dermatology follow-up.”

“The population was also older and mostly male, which limits how widely we can apply the findings. And in certain groups, like solid-organ transplant patients, the benefit was not as clear,” she added. 

Andrienko said the exposure measurement in this study relied on prescriptions and records rather than direct adherence monitoring, and the timing of when nicotinamide was started relative to UV exposure varies.

“These limitations mean the results should be interpreted as strong, suggestive evidence rather than definitive proof,” she explained. 

How effective is vitamin B3 against skin cancer?

Vitamin B3 should be viewed as an adjunct, not a replacement, for sunscreen and sun-protective behavior, Andrienko said.

“Sunscreen, protective clothing, and regular skin checks address the root exposure to UV and early detection, and they remain the cornerstone of prevention,” she explained. 

“Nicotinamide may add an internal layer of protection by improving DNA repair and reducing inflammation, which is valuable especially for people at higher risk or with prior skin cancers.” 

Andrenko advised thinking of nicotinamide as a complementary tool to use alongside, not instead of, the established measures.

As for nicotinamide’s effectiveness, Kopelman said it depends on the patient’s individual risk factors and health status.

“In people who are immunocompetent and high risk, particularly those who have already had a skin cancer, I do think nicotinamide can make a real difference if taken consistently at the studied dose of 500 milligrams twice daily,” she said. 

“The key is that patients need to actually take it regularly and continue all the other preventive strategies. 

“In immunosuppressed patients, like transplant recipients, the evidence is more mixed, and I’m more cautious in how I present its potential benefits,” she added. 

Skin cancer prevention tips 

Nicotinamide is a promising adjunctive preventive option, but following proven skin cancer prevention habits is key.

“My first-line recommendations are always daily broad-spectrum sunscreen, protective clothing like hats and UPF-rated shirts, and avoiding peak sun hours,” said Kopelman. 

Andrienko agreed. “Use SPF 30 or higher daily, apply it generously, and reapply it every two hours when outdoors,” she advised. 

“During peak hours, make sure you’re wearing sun-protective clothing, like wide-brimmed hats and UV-blocking sunglasses. You’ll also want to avoid intentional tanning and limit your time in direct sunlight,” she added. 

Checking for signs of skin damage is one of the most proactive skin cancer prevention habits you can complete. 

Andrienko recommends performing regular self-checks of your skin and seeing a dermatologist promptly if you notice any new, changing, or symptomatic spots. “Early detection matters,” she said. 

For those with a history of skin cancer, Andrienko recommended talking with your doctor to go over any current risks, medications, and individual factors. A healthcare professional can help determine whether 500 mg of nicotinamide twice daily is right for you.

While nicotinamide shows promise, sunscreen, protective clothing, and regular skin checks remain the best strategies for preventing skin cancer.

• The CDC’s vaccine panel, ACIP, changed its recommendations for childhood vaccines and updated COVID-19 shots, further limiting access.
• The changes align with vaccine skepticism within the Trump administration.
• HHS Secretary RFK Jr. reformed ACIP this year to include doctors and researchers who have publicly questioned vaccine safety.

The CDC’s vaccine panel voted this month to update the childhood vaccination schedule and narrow its recommendations for COVID-19 shots.

The changes, though modest, reflect the prominent vaccine skepticism within the Trump administration and could have far-reaching implications for public health, vaccine access, and insurance coverage.

Health and Human Services Secretary Robert F. Kennedy Jr. has pledged to “restore public trust” in the CDC and, more broadly, in vaccines and public health.

In June, Kennedy took the unprecedented step of firing all 17 members of the Advisory Committee for Immunization Practices (ACIP), a panel that advises the CDC on vaccine safety and efficacy, and makes recommendations.

Kennedy subsequently hand-picked new members, including doctors and researchers who have publicly questioned vaccine safety.

During two days of meetings described as tense and chaotic, ACIP members upended standard protocols by voting on changes to the measles, mumps, rubella, and varicella (MMRV) vaccine and the hepatitis B vaccine without a clear rationale, such as new safety data.

William Schaffner, MD, a professor of preventive medicine at Vanderbilt University who attended the meeting virtually, called the proceedings “disappointing and very concerning.”

“There is at least the appearance that there is skepticism, despite all the evidence about vaccine effectiveness and safety,” he told Healthline.

Schaffner pointed out the apparent lack of preparedness of the members of the panel. “It was certainly out of the ordinary, and there were major elements of disorganization and confusion in the meeting. Previous meetings were run very rigorously,” he said.

Charles Stoecker, PhD, J.P. Morgan Chase Professor in Healthcare Finance at the Tulane University Celia Scott Weatherhood School of Public Health and Tropical Medicine, said that internal working groups spend months and months preparing to present data — both clinical and economic — on specific issues in preparation for these meetings.

However, such typically meticulous preparation was not on display.

“The ACIP charter requires them to consider economic evaluation. Let’s see the cost-benefit analysis. Let’s see what kind of returns we get for what we’re going to expect. I didn’t see any of those things. So, I’m not sure how they consider themselves in compliance with that rule,” Stoecker told Healthline.

Instead, attendees were presented with anecdotal reports and unsupported claims, which Schaffner called “the equivalent of gossip.”

“It’s always good to raise questions. That’s what science does. But then you have to address the questions with rigor and on the basis of solid science, not rumors and anecdotes,” Schaffner said.

Changes to MMRV vaccine schedule

ACIP members voted 8–3 to stop recommending the combined MMRV vaccine for children under age 4.

Parents can still choose to have their children receive the measles, mumps, and rubella (MMR) vaccine and the varicella vaccine separately rather than as a single combined shot.

The panel said it based its decision on data showing that the combined MMRV vaccine carries a slightly higher risk of febrile seizures. According to the panel, MMRV doubles that risk compared with giving the measles, mumps, and rubella (MMR) and varicella vaccines separately, without offering additional benefits.

However, this data is not new, raising questions about why the panel acted now. Furthermore, even though the risk of febrile seizures is doubled with MMRV, the overall risk remains very low, and such seizures are typically not serious in infants.

“They tried to solve a problem that didn’t exist. Parents who worry about febrile seizures could already choose separate shots,” said Jake Scott, MD, clinical associate professor of infectious diseases at Stanford Medicine.

According to data presented at the meetings, only about 15% of parents choose the MMRV combination vaccine, with the rest opting for separate MMR and varicella shots. For that minority, the combined vaccine will no longer be available.

“These people [on the ACIP panel] supposedly advocate for medical freedom, and they eliminated parental choice,” said Scott. The result of that, he said, will be “more needle sticks for crying toddlers.”

Delayed ACIP vote on hepatitis B shot for children

The ACIP panel also, after heated debate, indefinitely tabled a vote on delaying the hepatitis B vaccine, currently given at birth.

Like the MMRV vaccine, the panel did not present new safety data as a rationale for a potential change in the vaccine schedule.

“They created a lot of doubt and they questioned 40 years of success for no justifiable reason. Then they tabled the vote. So they accomplished, I think, maximum damage to public confidence with no policy change,” said Scott.

Hepatitis B is an incurable infection that is the leading cause of liver cancer worldwide. The routine birth dose of the hepatitis B vaccine in the United States has been hailed as one of the country’s major public health successes.

“No country, once initiating the birth dose, has ever gone back to the bad old days. We’re discussing going back to the bad old days,” said Schaffner.

The vaccine is given at birth to prevent transmission from mothers with hepatitis B and to reduce the risk of chronic infection.

However, the Trump administration has characterized hepatitis B primarily as a sexually transmitted disease, insisting that newborns don’t need the shot.

In a special announcement on Tylenol use during pregnancy and autism risk on Monday, President Trump suggested delaying the hepatitis B vaccine until age 12.

When or if the ACIP will vote again on the issue is unclear.

“It’s with great relief that they decided to indefinitely table that,” said Stoecker.

COVID-19 vaccine no longer universally recommended

The panel also decided to abandon a universal recommendation for updated COVID-19 vaccines, unanimously voting to adopt an “individual decision-making” approach instead.

Under the new guidance, U.S. adults 65 and older are advised to get the vaccine using this approach.

People between the ages of six months and 64 are not prohibited from getting the shot, but are encouraged to consult their healthcare professional to weigh the risks and benefits before vaccination.

A more extreme proposal — which would have required states to mandate prescriptions for COVID-19 vaccines — narrowly failed to pass. The final vote was 6–6, with the panel chair casting the tie-breaking vote to defeat it.

The new recommendations have led to confusion among patients, pharmacists, and doctors alike.

“There are issues of how this shared clinical decision making model will work in practice. Can anyone then come into a pharmacy and say, give me the vaccine? Or are they going to have to provide some documentation?” said Schaffner.

Stoecker echoed those concerns, noting that pharmacies and pharmacists could find themselves in trouble.

“If the ACIP introduces this kind of less strong recommendation, is it still recommended? What we’ve seen is that places like Walgreens and CVS start holding back. They don’t want to get to a place where their pharmacists are put in legal jeopardy,” Stoecker said.

For now, insurance coverage of COVID-19 shots will stay in place for most. AHIP, a trade association of health insurance companies that includes Medicare Advantage and Medicaid, has stated it will continue to cover COVID-19 and flu vaccines through the end of 2026.

Vaccine changes may signal a larger agenda

ACIP’s new recommendations for MMRV and COVID-19 vaccines are modest changes and are unlikely to significantly affect vaccine access for most Americans. However, experts say that they may portend more severe changes on the horizon.

“The bigger problem is the signal,” said Scott.

“Pediatricians and family doctors rely on stable vaccine recommendations. So when a 20-year-old policy suddenly changes without new safety data, it makes the providers question what’s next. Will other combination vaccines be eliminated?” he warned.

Stoecker points out that weakening recommendations will likely have a trickle down effect on insurance coverage and vaccine uptake.

“It’s kind of amazing how price-responsive people are to these things. So if you start charging for these vaccines, almost assuredly, we’re going to see the coverage rates go down. That’s what previous experience has told us,” he said.

Vaccine policies have also become increasingly politicized, playing out in opposite ways across blue and red state lines.

Florida plans to remove all school vaccine mandates, while states like Louisiana, Texas, and Idaho push to follow suit. Meanwhile, California and New Mexico are expanding access to COVID-19 vaccines.

The politicization of vaccine policy and public health is deeply concerning to doctors in the field.

“Diseases don’t respect state lines,” said Scott.

“Viruses exploit every gap in population immunity. So these disparate policies create this sort of swiss cheese model where eventually the holes align.”