An aggressive infectionThe patient was a 70-year-old resident of Washoe County, Nevada who was admitted to an acute care hospital in August 2016 after an extended trip to India. She was given a primary diagnosis of systemic inflammatory response syndrome, likely resulting from an infected right hip seroma. The infection was serious; none of the 14 antibiotics physicians used to treat the woman worked. After the CRE—identified as Klebsiella pneumoniae, one of the more common types of CRE—was confirmed by lab testing, an isolate from a wound specimen was sent to the CDC for further susceptibility testing and to determine the mechanism of resistance. That testing confirmed the presence of New Delhi metallo-beta-lactamase (NDM-1), an enzyme that directly breaks down carbapenems, a powerful class of antibiotics that are often used to treat multidrug-resistant infections.In addition, the CDC’s antimicrobial testing showed the isolate was resistant to 26 different antibiotics, including all aminoglycosides and polymixins—another class of last-resort antibiotics. It was also intermittently resistant to tigecycline, an antibiotic developed specifically to overcome drug-resistant organisms. Essentially, there were no treatment options.