Nationwide Outbreak of <i>Candida auris</i> Infections Driven by COVID-19 Hospitalizations, Israel, 2021–20221
Roni Biran, Regev Cohen, Talya Finn, Tal Brosh‐Nissimov, Galia Rahav, Dafna Yahav, Sharon Amit, Yael Shachor‐Meyouhas, Alaa Atamna, Jihad Bishara, Liat Ashkenazi‐Hoffnung, Haim Ben Zvi, Mirit Hershman-Sarafov, Shlomo Maayan, Yasmin Maor, Orna Schwartz, Oren Zimhony, Jonathan Lellouche, Meital Elbaz, Ela O Burdelova, Naama Mizrahi, Anna Novikov, Oryan Henig, Ronen Ben‐Ami
Abstract
We report an outbreak of Candida auris across multiple healthcare facilities in Israel. For the period of May 2014-May 2022, a total of 209 patients with C. auris infection or colonization were identified. The C. auris incidence rate increased 30-fold in 2021 (p = 0.00015), corresponding in time with surges of COVID-19-related hospitalization. Multilocus sequence typing revealed hospital-level outbreaks with distinct clones. A clade III clone, imported into Israel in 2016, accounted for 48.8% of typed isolates after January 2021 and was more frequently resistant to fluconazole (100% vs. 63%; p = 0.00017) and voriconazole (74% vs. 5.2%; p<0.0001) than were non-clade III isolates. A total of 23% of patients had COVID-19, and 78% received mechanical ventilation. At the hospital level, outbreaks initially involved mechanically ventilated patients in specialized COVID-19 units and then spread sequentially to ventilated non-COVID-19 patients and nonventilated patients.