The incidence of the multidrug-resistant fungal pathogen Candida auris increased dramatically in Israeli hospitals in 2021 and 2022, driven primarily by COVID-19 surges and mechanical ventilation, Israeli researchers reported last week in Emerging Infectious Diseases.
In a nationwide survey, researchers identified 209 patients with C auris infection or colonization from May 2014 to May 2022. Twenty-four of those cases were reported in seven hospitals from May 2014 to December 2020. The C auris incidence rate increased 30-fold in 2021, with an annual incidence of 120 cases reported from 10 hospitals and 3 long-term care facilities. During 2021 and 2022, C auris incidence corresponded with COVID-19 surges in Israel, peaking during the Alpha (January to March 2021), Delta (June to November 2021), and Omicron (January to May 2022) variant waves.
Almost one quarter (23%) of patients with C auris infection or colonization were infected with SARS-CoV-2, and 78% received mechanical ventilation. Analysis of outbreaks at the three hospitals with the most cases indicated C auris spread first among mechanically ventilated COVID-19 patients, then infected ventilated non-COVID-19 patients in intermediate care units and from there spread to non-ventilated patients.
Rise of worrisome clade 3
Multilocus sequence typing revealed that a clade 3 clone, responsible for three cases prior to December 2020, accounted for 55.8% of isolates collected after January 2021. Clade 2 isolates were more frequently resistant to fluconazole (100% vs 63%) and voriconazole (74% vs 5.2%) than non–clade 3 isolates.
The study authors say the use of double-gloving, poor adherence to hand hygiene, and inadequate disinfection of shared medical devices and equipment in COVID-19 units are potential explanations for the C auris outbreaks. They warn that the pathogen appears set to become endemic in some hospitals.
Continued surveillance and implementation of infection control measures, focusing on debilitated patients and those receiving mechanical respiratory support, are essential.
"Continued surveillance and implementation of infection control measures, focusing on debilitated patients and those receiving mechanical respiratory support, are essential to control the spread of C. auris," they wrote.