How did they die? Nevada limits ‘superbug’ death data
LAS VEGAS (KLAS) — As testing reveals more cases involving the “superbug” known as candida auris, the medical field is struggling with a tough question. Are people dying “from” C. auris, or are they just dying “with” C. auris?
It’s an uncomfortable question. So much so that the Nevada Division of Public and Behavioral Health (DPBH) is no longer releasing any data regarding deaths involving one of the five CDC “superbugs” classified as an urgent health threat. The last time the CDC provided case counts by state, Nevada accounted for 14% of the cases in the U.S.
In November of 2022, 8 News Now reported on statistics from DPBH that showed 63 deaths linked to C. auris. Our report stated, “The deaths were not necessarily caused by the fungus” — in the second paragraph. But that’s the last time we’ve been able to report information about deaths. Data released in March 2023, November 2023 and February 2024 excluded any information on deaths.
When asked three months ago about information on C. auris deaths, DPBH gave this reply:
In April 2022, the Division of Public and Behavioral Health (DPBH) requested that health care facilities report cases of C. auris to the State Healthcare Associated Infections Program. The DPBH previously tallied the number of deaths among reported C. auris cases. However, patients who contract C. auris oftentimes have additional serious medical conditions that increase their risk of death. It is extremely difficult to determine whether deaths among such patients are attributable only to C. auris and not due to a pre-existing condition. In addition, there is no national case definition for a death caused by C. auris. Therefore, it was decided to discontinue reporting numbers of deaths among patients with C. auris as such reporting was proven to be inaccurate and unfeasible at this time.
The case total now is nearly four times higher now than when DPBH last provided information on deaths. Cases have grown from 774 in November 2022 to 2,870 now. But there’s no data on deaths.
“You’re going to find a reluctance among people who are dealing with it in their hospital facilities or their state health departments because it is such a big challenge,” Dr. Neil Clancy told 8 News Now. Clancy is an infectious disease specialist and a professor of medicine at the University of Pittsburgh.
And a death toll isn’t critical to understanding the seriousness of C. auris, Clancy said.
“What’s most relevant is knowing the number of cases and colonization that you’re detecting. Because that gives you a sense of the extent to which it’s out there and it’s being found,” he said.
“Honestly, as a physician and an infectious diseases practitioner, the mortality figure to me is probably less important in the sense that, like I said, it’s very, very difficult with these type of infections and the type of patients who develop these types of infections to really know with everything that’s going on medically how much is the candida auris actually contributing to an endpoint like death,” Clancy said.
Why is it so hard to determine how a patient died?
Clancy said people who are diagnosed with C. auris infections often have serious underlying medical conditions that predispose them to infections. “So it’s often very hard in individual cases to know whether people are dying ‘from’ the candida infection, or ‘with’ the candida infection,” he said.
“In half the patients, is candida contributing to the death? Is it less? Is it more? You know, it’s very hard to get a precise bead on that,” Clancy said. But his research provides help in digging out an answer.
“If you look at all candida infections, 20% to 40% of patients with deep infections … with any candida species mortality is typically on the order of 20 to 40%,” he said. But he emphasized that statistic relates only to deep infections, not skin infections or vaginal infections that aren’t uncommon.
DPBH data doesn’t include the level of detail on clinical cases that would be needed to estimate how many deaths were because of C. auris.
“I think it’s important that the public be aware of these type of things,” Clancy said. “By the same token, I don’t think this is anything that they need to fear to an extent that they shouldn’t be seeking medical care, shouldn’t be going to hospitals, shouldn’t be getting what they need to get done for their health and well-being.”
Clancy directs the mycology program at the University of Pittsburgh. While C. auris is getting more attention these days, it’s not the only fungal infection making news. He said there are many factors contributing to the prevalence of infections including climate change and agricultural practices.
Studies continue, including research into how bacteria and fungi interact in the human body.
“We all carry millions and millions of bacteria and fungi in our bodies and most notably in our guts — our gastrointestinal tract. So we carry big burdens of these. If they stay in our gastrointestinal tract then they’re what we call our ‘normal flora.’ But if they get into places where they shouldn’t be such as the bloodstream or some other normally sterile tissue site, then they become a problem,” Clancy said.
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