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

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 out-breaks 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 voricon-azole (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.

Automated summary

We present a report on the outbreak of Candida auris in multiple healthcare facilities in Israel. A total of 209 patients with C. auris infection or colonization were identified from May 2014 to May 2022. The incidence rate of C. auris increased significantly in 2021, coinciding with the surge of COVID-19 hospitalizations. Outbreaks occurred at the hospital level with distinct clones, and a clade III clone, imported in 2016, accounted for a high proportion of isolates after January 2021 and exhibited higher resistance to fluconazole and voriconazole compared to non-clade III isolates. 23% of patients had COVID-19, and the outbreaks initially affected mechanically ventilated patients in specialized COVID-19 units before spreading to non-COVID-19 patients and nonventilated patients.