Invasive infections by a multidrug-resistant organism known as Candida auris (C. auris) are on the rise worldwide, causing severe illnesses and sometimes death in patients in health care facilities and long-term care centers.

More than 30 countries – including the United States – have reported cases of C. auris, described as an urgent threat by the Centers for Disease Control and Prevention (CDC). As of February 2019, nearly 600 cases have been confirmed in the U.S., mostly in New York City, New Jersey and the Chicago area. The CDC does not report any Iowa cases.

Medicines commonly used to treat Candida infections often are not effective with C. auris and other organisms dubbed as “nightmare bacteria.” According to the CDC, antibiotics often have been used inappropriately for so long that the infectious organisms adapt to the drugs designed to kill them.

“Patients who have been hospitalized in a health care facility a long time, have a central venous catheter, or other lines or tubes entering their body, or have previously received antibiotics or antifungal medications, appear to be at highest risk of infection with this yeast,” the CDC says.

A 2013 CDC report estimated at least 2 million people in the United States become infected with multi-drug resistant organisms (MDROs) – including C. auris – and about 23,000 die.

Researchers at Washington University School of Medicine, however, estimate the number of MDRO infections may be significantly higher than the CDC estimated six years ago. Published in January 2019, the Washington University study used data from 2010 to approximate the total number of U.S. deaths due to MDROs may be as high as 153,000 or more, and that these numbers will likely increase.

The significant difference, according to the authors, may be due to “insufficient national reporting rates” and the lack of codes used to describe a particular diagnosis.

“Our estimates illustrate a need for better surveillance and reporting mechanisms for MDRO infections,” authors of the study reported. “With rampant over-use of antibiotics, establishment of MDRO breeding and transmission centers (long-term acute-care hospitals and nursing facilities), and increasing rates of iatronigenic (misdiagnosis or accidental infection) immunosuppression, the population at risk for MDRO infections and the likelihood of drug resistance will continue to increase.”

The CDC reports that it will publish an updated report about MDROs in fall 2019.

The State Hygienic Laboratory confirmed more than 30 isolates of carbapenem-resistant Enterobacteriaceae (CRE) in samples submitted from healthcare facilities throughout Iowa in 2017. CRE are considered by the CDC an immediate public health threat requiring urgent and aggressive action.

The State Hygienic Laboratory is a member of the Antibiotic Resistance Lab Network (AR Lab Network), launched in 2016 to rapidly detect antibiotic resistant organisms and respond to outbreaks.

The AR Lab Network testing program was started by the CDC to use public health surveillance to address gaps in detecting resistance to antibiotics and other drugs used to treat infections. As part of the program, a regional laboratory network was established to detect resistant bacterial strains – including C. auris – and create a specimen repository to facilitate development and evaluation of diagnostic tests and treatments.