Nationwide Outbreak of Candida auris Infections Driven by COVID-19 Hospitalizations, Israel, 2021-2022

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Epidemiology

Background:

• Candida auris is an emerging multidrug-resistant fungal pathogen.
• Healthcare-associated outbreaks of C. auris pose significant public health challenges.
• The COVID-19 pandemic may have influenced the epidemiology of C. auris.

Purpose of the Study:

• To describe the epidemiology and molecular characteristics of a Candida auris outbreak in Israel.
• To investigate the association between C. auris incidence and COVID-19 surges.
• To identify risk factors and transmission patterns of C. auris in healthcare settings.

Main Methods:

• Retrospective analysis of C. auris cases from May 2014 to May 2022.
• Multilocus sequence typing (MLST) to characterize C. auris isolates.
• Comparison of patient demographics, clinical characteristics, and outcomes.

Main Results:

• A 30-fold increase in C. auris incidence was observed in 2021, correlating with COVID-19 hospitalizations.
• Multilocus sequence typing identified distinct hospital-level outbreaks.
• A clade III clone, imported in 2016, became dominant and exhibited higher resistance to fluconazole and voriconazole.
• Patients with COVID-19 and mechanical ventilation were disproportionately affected.
• Outbreaks spread from COVID-19 units to other patient populations.

Conclusions:

• The study highlights a significant C. auris outbreak in Israel, linked to COVID-19 pandemic pressures.
• The emergence and spread of a multidrug-resistant clade III clone is a major concern.
• Enhanced surveillance and infection control measures are crucial to manage C. auris outbreaks in healthcare facilities.