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:10.3201/eid2907.221888

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 BurdelovaNaama Mizrahi, Anna Novikov, Oryan Henig, Ronen Ben-Ami

Ben-Gurion University of the Negev, Tel Aviv University, Technion - Israel Institute of Technology

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	1302-1311
Number of pages	10
Journal	Emerging Infectious Diseases
Volume	29
Issue number	7
DOIs	https://doi.org/10.3201/eid2907.221888
State	Published - 1 Jul 2023

Keywords

Antifungal Agents/pharmacology
COVID-19
COVID-19/epidemiology
Candida auris
Candida/genetics
Candidiasis, Invasive/drug therapy
Disease Outbreaks
Hospitalization
Humans
Israel
Israel/epidemiology
Microbial Sensitivity Tests
SARS-CoV-2
antifungal susceptibility
coronavirus disease
drug resistance
epidemiology
fungi
multilocus sequence typing
respiratory infections
severe acute respiratory syndrome coronavirus 2
viruses
zoonoses

All Science Journal Classification (ASJC) codes

Epidemiology
Microbiology (medical)
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3201/eid2907.221888

Cite this

Biran, R., Cohen, R., Finn, T., Brosh-Nissimov, T., Rahav, G., Yahav, D., Amit, S., Shachor-Meyouhas, Y., Atamna, A., Bishara, J., Ashkenazi-Hoffnung, L., Zvi, H. B., Hershman-Sarafov, M., Maayan, S., Maor, Y., Schwartz, O., Zimhony, O., Lellouche, J., Elbaz, M., ... Ben-Ami, R. (2023). Nationwide Outbreak of Candida auris Infections Driven by COVID-19 Hospitalizations, Israel, 2021–2022. Emerging Infectious Diseases, 29(7), 1302-1311. https://doi.org/10.3201/eid2907.221888

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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.",

keywords = "Antifungal Agents/pharmacology, COVID-19, COVID-19/epidemiology, Candida auris, Candida/genetics, Candidiasis, Invasive/drug therapy, Disease Outbreaks, Hospitalization, Humans, Israel, Israel/epidemiology, Microbial Sensitivity Tests, SARS-CoV-2, antifungal susceptibility, coronavirus disease, drug resistance, epidemiology, fungi, multilocus sequence typing, respiratory infections, severe acute respiratory syndrome coronavirus 2, viruses, zoonoses",

author = "Roni Biran and Regev Cohen and Talya Finn and Tal Brosh-Nissimov and Galia Rahav and Dafna Yahav and Sharon Amit and Yael Shachor-Meyouhas and Alaa Atamna and Jihad Bishara and Liat Ashkenazi-Hoffnung and Zvi, {Haim Ben} and Mirit Hershman-Sarafov and Shlomo Maayan and Yasmin Maor and Orna Schwartz and Oren Zimhony and Jonathan Lellouche and Meital Elbaz and Ela Burdelova and Naama Mizrahi and Anna Novikov and Oryan Henig and Ronen Ben-Ami",

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month = jul,

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doi = "10.3201/eid2907.221888",

language = "الإنجليزيّة",

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Biran, R, Cohen, R, Finn, T, Brosh-Nissimov, T, Rahav, G, Yahav, D, Amit, S, Shachor-Meyouhas, Y, Atamna, A, Bishara, J, Ashkenazi-Hoffnung, L, Zvi, HB, Hershman-Sarafov, M, Maayan, S, Maor, Y, Schwartz, O, Zimhony, O, Lellouche, J, Elbaz, M, Burdelova, E, Mizrahi, N, Novikov, A, Henig, O & Ben-Ami, R 2023, 'Nationwide Outbreak of Candida auris Infections Driven by COVID-19 Hospitalizations, Israel, 2021–2022', Emerging Infectious Diseases, vol. 29, no. 7, pp. 1302-1311. https://doi.org/10.3201/eid2907.221888

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T1 - Nationwide Outbreak of Candida auris Infections Driven by COVID-19 Hospitalizations, Israel, 2021–2022

AU - Biran, Roni

AU - Cohen, Regev

AU - Finn, Talya

AU - Brosh-Nissimov, Tal

AU - Rahav, Galia

AU - Yahav, Dafna

AU - Amit, Sharon

AU - Shachor-Meyouhas, Yael

AU - Atamna, Alaa

AU - Bishara, Jihad

AU - Ashkenazi-Hoffnung, Liat

AU - Zvi, Haim Ben

AU - Hershman-Sarafov, Mirit

AU - Maayan, Shlomo

AU - Maor, Yasmin

AU - Schwartz, Orna

AU - Zimhony, Oren

AU - Lellouche, Jonathan

AU - Elbaz, Meital

AU - Burdelova, Ela

AU - Mizrahi, Naama

AU - Novikov, Anna

AU - Henig, Oryan

AU - Ben-Ami, Ronen

PY - 2023/7/1

Y1 - 2023/7/1

N2 - 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.

AB - 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.

KW - Antifungal Agents/pharmacology

KW - COVID-19

KW - COVID-19/epidemiology

KW - Candida auris

KW - Candida/genetics

KW - Candidiasis, Invasive/drug therapy

KW - Disease Outbreaks

KW - Hospitalization

KW - Humans

KW - Israel

KW - Israel/epidemiology

KW - Microbial Sensitivity Tests

KW - SARS-CoV-2

KW - antifungal susceptibility

KW - coronavirus disease

KW - drug resistance

KW - epidemiology

KW - fungi

KW - multilocus sequence typing

KW - respiratory infections

KW - severe acute respiratory syndrome coronavirus 2

KW - viruses

KW - zoonoses

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DO - 10.3201/eid2907.221888

M3 - مقالة

C2 - 37347492

SN - 1080-6040

VL - 29

SP - 1302

EP - 1311

JO - Emerging Infectious Diseases

JF - Emerging Infectious Diseases

IS - 7

ER -

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

Abstract

Keywords

All Science Journal Classification (ASJC) codes

UN SDGs

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