What You Need To Know
Summary:
- The Communicable Disease Service (CDS) is issuing a Health Advisory about infections with a rare strain of extensively drug-resistant Acinetobacter baumannii and New Delhi Metallo-ß-lactamase (NDM)-producing Enterobacter cloacae complex identified among patients in five other states.
- Most affected case-patients have had burns and/or complex wounds, such as decubitus ulcers, diabetic foot ulcers and pressure ulcers.
- Healthcare facilities, providers, clinical and reference laboratories are asked to report cases of carbapenemase-producing organisms, carbapenem-resistant Enterobacter cloacae complex and extensively drug-resistant Acinetobacter baumannii that meet established reporting and submission criteria to NJDOH’s CDS.
Background
As of November 14, 2025, the Centers for Disease Control and Prevention (CDC) in partnership with state and local health departments identified 28 case-patients in five states (CO, FL, GA, KY, TX) with specimen collection dates from April 2025 to present. All 28 case-patients had Acinetobacter baumannii isolates harboring the blaOXA-23 carbapenemase gene (or the variant blaOXA-1325) and are Oxford MLST (STOX) 540, an uncommon sequence type (ST) in the United States. Specimen sources for A. baumannii include wounds (n = 14), respiratory tract (7), urine (3), and blood (2). All A. baumannii isolates within this multistate cluster have a minocycline minimum inhibitory concentration (MIC) value =4 µg/ml.
Three case-patients in three states were also identified to be coinfected with Enterobacter cloacae complex harboring the blaNDM-1 carbapenemase gene and are ST 270 (Miyoshi-Akiyama scheme). Enterobacter cloacae complex case-patients within this cluster were identified as E. hormaechei by sequence-based taxonomy using average nucleotide identity (ANI) or 16S ribosomal RNA sequencing analysis. Antimicrobial susceptibility testing of Enterobacter cloacae complex isolates were shown to be susceptible to amikacin, gentamicin, tigecycline, aztreonam-avibactam, and cefiderocol.
Preliminary epidemiologic findings indicate that most affected case-patients had burns or complex wounds, such as third-degree burns, diabetic foot ulcers, and decubitus ulcers. For the purposes of this investigation, complex wounds are defined as wounds involving more extensive damage that may affect deeper layers of skin and underlying tissue (e.g., subcutaneous tissue, muscle and bone) and requiring specialized wound care (e.g., debridement, surgery, specialized dressings or products). There are no known epidemiological links between case-patients from different states; however, 22 patients are part of two acute care hospital clusters in two states where patients in each cluster had overlapping stays on common units.
Within each species, isolates are closely related by whole genome sequencing (WGS) analysis and are distinct from other U.S. isolates, suggesting a common source such as a medical product. Investigations to identify common exposures, including medical products and devices, among patients are underway.
Recommendations for Clinical and Reference Laboratories
- When Enterobacter cloacae complex isolates are identified that are resistant to carbapenems (ertapenem, imipenem, meropenem, or doripenem) and not susceptible to ceftazidime-avibactam (if tested) or meropenem-vaborbactam (if tested), laboratories should contact NJDOH CDS and submit these isolates to the New Jersey Public Health and Environmental Laboratory (NJ PHEL) for carbapenem resistance mechanism testing (see “Contact Information” and “Resources”).
- When Enterobacter cloacae complex isolates are identified that harbor the blaNDM carbapenemase gene, laboratories should contact NJDOH CDS and submit these isolates to NJ PHEL for whole genome sequencing.
- Laboratories should immediately contact NJDOH CDS to report culture from ANY body site with A. baumannii resistant to carbapenems (imipenem, meropenem, or doripenem) and not susceptible to minocycline (MIC >= 4 µg/ml) in a specimen collected from a patient on or after April 1, 2025, if the patient’s isolate is still available for further testing.
- Laboratories that identify extensively drug-resistant Acinetobacter baumannii should save the isolate and report it to NJDOH CDS for potential further characterization.
- To discuss submission of isolates for mechanism testing or further characterization, reach out to NJDOH staff.
Recommendations for Healthcare Providers
- Immediately report all cases of NDM-producing Enterobacter cloacae complex to NJDOH CDS.
- Closely monitor for clusters of extensively drug-resistant Acinetobacter baumannii, particularly among patients with burns or complex wounds. Any suspected clusters that have associated cases with isolates available for further testing should be immediately reported to NJDOH CDS.
- Continue to report Acinetobacter baumannii cases to NJDOH CDS as outlined in established submission criteria.
- Healthcare providers or facilities should immediately contact NJDOH CDS to report culture from ANY body site with A. baumannii resistant to carbapenems (imipenem, meropenem, or doripenem) and not susceptible to minocycline (MIC >= 4 µg/ml) in a specimen collected from a patient with wounds or burns on or after April 1, 2025, if the patient’s isolate is still available for further testing.
- Place patients that are infected or colonized with NDM Enterobacter or extensively drug-resistant A. baumannii and admitted to acute care settings in isolation and use Contact Precautions. For residents of skilled nursing facilities who are infected or colonized NDM Enterobacter or extensively drug-resistant A. baumannii, use Enhanced Barrier Precautions if the resident does not have an indication for Contact Precautions.