First Candida auris Outbreak during a COVID-19 Pandemic in a Tertiary-Care Center in Lebanon

Abstract

Candida auris is an emerging fungal pathogen considered as a global health threat. Recently there has been growing concern regarding drug resistance, difficulty in identification, as well as problems with eradication. Although outbreaks have been reported throughout the globe including from several Arab countries, there were no previous reports from Lebanon. We herein report the first cases of C. auris infection from the American University of Beirut Medical Center, a tertiary care center in Lebanon describing the clinical features of the affected patients in addition to the infection control investigation and applied interventions to control the outbreak. Fourteen patients with C. auris infection/colonization identified using MALDI-TOF and VITEK 2- Compact system were reported over a period of 13 weeks. Patients were admitted to four separate critical care units. All of them came through the emergency room and had comorbid conditions. Half of the patients were infected with COVID-19 prior to isolation of the C. auris. C. auris was isolated from blood (two isolates), urine (three isolates), respiratory tract (10 isolates) and skin (one isolate). All the patients had received broad spectrum antibiotics prior to isolation of C. auris. Six patients received antifungal treatment, while the remaining eight patients were considered colonized. Environmental cultures were taken from all four units and failed to isolate the organism from any cultured surfaces. A series of interventions were initiated by the Infection Prevention and Control team to contain the outbreak. Rapid detection and reporting of cases are essential to prevent further hospital transmission. A national standardized infection control registry needs to be established to identify widespread colonization.

SCA Medium: A New Culture Medium for the Isolation of All Candida auris Clades

“…This ensures limiting and controlling a possible nosocomial outbreak of a pathogen with fatal consequences and limited therapeutic options. This need is emphasized in the current COVID-19 pandemic we are living in, whereby an increasing amount of critically ill, immunocompromised patients populate the hospitals [22][23][24]. The gold standard of diagnosis remains molecular identification by sequencing and/or real-time PCR [9][10][11][12].…”

SCA Medium: A New Culture Medium for the Isolation of all <em>Candida auris</em> Clade

“…The use of our developed medium enables the rapid, specific isolation of C. auris strains and helps in timely management of patients and resources to limit the occurrence of C. auris outbreaks. We propose an implementation of SCA medium in routine clinical mycology for screening skin, urine, vaginal and blood samples, especially in high-risk populations [13,15]. This SCA medium will further enhance our understanding of the phenotypic characteristics of C. auris and future isolates, most importantly allowing an accurate study of their antifungal resistance profiles.…”

Epidemiology of Systemic Mycoses in the COVID-19 Pandemic

“…Co-infections by Candida have been observed in both women and men, but predominantly in men over the age of 40 [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. The predisposing factors of candidiasis were multiple, including mechanical ventilation, placement of a central venous catheter, diabetes mellitus, antibiotics treatment, hospitalization time, anti-inflammatory treatment, and cancer [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , …”

“…Other less common risk factors were asthma, HIV, and surgery, among others [ 34 , 35 , 36 , 38 , 41 , 45 , 47 , 48 , 49 , 50 , 52 , 56 , 60 ]. The diagnosis was performed through culture, PCR, sequencing, and MALDI-TOF [ 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. The most identified pathogen was C. albicans , followed by C. glabrata , C. parapsilosis , C. tropicalis , C. auris , C. krusei , C. lusitaniae , C. inconspicua , C. dubliniensis , C. orthopsilosis , Candida spp.…”