Emerging Infectious Diseases (Jul 2023)

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

  • 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 Burdelova,
  • Naama Mizrahi,
  • Anna Novikov,
  • Oryan Henig,
  • Ronen Ben-Ami

DOI
https://doi.org/10.3201/eid2907.221888
Journal volume & issue
Vol. 29, no. 7
pp. 1297 – 1301

Abstract

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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.

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