Outbreak of Candida auris infection in a COVID-19 hospital in Mexico

Villanueva-Lozano, Hiram; Treviño-Rangel, Rogelio de J.; González, Gloria M.; Ramírez-Elizondo, María Teresa; Lara-Medrano, Reynaldo; Alemán-Bocanegra, Mary Cruz; Guajardo-Lara, Claudia Elena; Gaona-Chávez, Natalia; Castilleja‐Leal, Fernando; Torre‐Amione, Guillermo; Martínez‐Reséndez, Michel F.

doi:10.1016/j.cmi.2020.12.030

Cited by 151 publications

(160 citation statements)

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“…An increasing number of studies have documented a higher incidence of candidemia in the post-COVID-19 era and its association with high mortality despite antifungal treatment [3][4][5][6][7][8][9]20]. In this retrospective, multicenter study performed in Iran, we confirmed a high mortality rate among patients with CAC, which further highlights the vital importance of timely diagnosis and administration of proper antifungal treatment.…”

Section: Discussionsupporting

confidence: 74%

“…The identification of C. albicans and C. glabrata as the leading agents of CAC is in line with the reports from Oman [9], Italy [21], and the United Kingdom [6,20]; still, this result does not rule out the possibility that other Candida spp. may cause outbreaks among critically ill patients with COVID-19, as evidenced by the finding that C. auris was the main causative species of CAC in India [7], Mexico [8], and Brazil [26]. Altogether, the epidemiological profile of patients with CAC observed in this study may reflect the endogenous rather than nosocomial route of Candida infection, whereas the single case of R. mucilaginosa infection could have an environmental origin.…”

Section: Discussionmentioning

confidence: 56%

“…An increasing body of evidence points to a higher incidence of candidemia in the post-COVID-19 than in the pre-COVID-19 era [4][5][6]. The mortality rate among patients with COVID-19-associated candidemia (CAC) is high [5][6][7][8][9], reaching up to 83% despite antifungal treatment [8]. Further complicating matters is the emergence of antifungal drugresistant Candida isolates [7,8,10], especially pan-echinocandin-resistant C. glabrata [10] and multidrug-resistant C. auris [7,8], which may potentially cause therapeutic failure, unfavorable clinical outcomes, and outbreaks.…”

Section: Introductionmentioning

confidence: 99%

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Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs

Arastehfar

Shaban

Zarrinfar

et al. 2021

JoF

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As a novel risk factor, COVID-19 has led to an increase in the incidence of candidemia and an elevated mortality rate. Despite being of clinical importance, there is a lack of data regarding COVID-19-associated candidemia (CAC) among Iranian patients. Therefore, in this retrospective study, we assessed CAC epidemiology in the intensive care units (ICUs) of two COVID-19 centers in Mashhad, Iran, from early November 2020 to late January 2021. Yeast isolates from patients’ blood were identified by 21-plex polymerase chain reaction (PCR) and sequencing, then subjected to antifungal susceptibility testing according to the CLSI M27-A3 protocol. Among 1988 patients with COVID-19 admitted to ICUs, seven had fungemia (7/1988; 0.03%), among whom six had CAC. The mortality of the limited CAC cases was high and greatly exceeded that of patients with COVID-19 but without candidemia (100% (6/6) vs. 22.7% (452/1988)). In total, nine yeast isolates were collected from patients with fungemia: five Candida albicans, three C. glabrata, and one Rhodotorula mucilaginosa. Half of the patients infected with C. albicans (2/4) were refractory to both azoles and echinocandins. The high mortality of patients with CAC, despite antifungal therapy, reflects the severity of the disease in these patients and underscores the importance of rapid diagnosis and timely initiation of antifungal treatment.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

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Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs

Arastehfar

Shaban

Zarrinfar

et al. 2021

JoF

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“…Indeed, in a context where the existing ICU capacity had been overwhelmed by the large number of COVID-19 patients requiring critical care and the conventional infection prevention and control measures were challenging (e.g., cohorting), the prolonged use of personal protective equipment (PPE) by the healthcare personnel may have inadvertently mediated a silent dissemination of this fungal pathogen. Epidemiological alerts of C. auris outbreaks occurring in healthcare facilities in the context of the COVID-19 pandemic have been recently documented also in Florida, Mexico, and India [34][35][36]. Of note, these reports consistently remarked the role that a possible low compliance to the guidelines for the correct use of PPE (e.g., experienced during anticipated or existing shortages) may have played in environmental contamination and transmission of C. auris, thus providing further evidence about major risk factors likely associated with an enhanced nosocomial spread of this organism during the pandemic.…”

Section: Discussionmentioning

confidence: 99%

Molecular Epidemiological Investigation of a Nosocomial Cluster of C. auris: Evidence of Recent Emergence in Italy and Ease of Transmission during the COVID-19 Pandemic

Pilato

Codda

Ball

et al. 2021

JoF

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Candida auris is an emerging MDR pathogen raising major concerns worldwide. In Italy, it was first and only identified in July 2019 in our hospital (San Martino Hospital, Genoa), where infection or colonization cases have been increasingly recognized during the following months. To gain insights into the introduction, transmission dynamics, and resistance traits of this fungal pathogen, consecutive C. auris isolates collected from July 2019 to May 2020 (n = 10) were subjected to whole-genome sequencing (WGS) and antifungal susceptibility testing (AST); patients’ clinical and trace data were also collected. WGS resolved all isolates within the genetic clade I (South Asian) and showed that all but one were part of a cluster likely stemming from the index case. Phylogenetic molecular clock analyses predicted a recent introduction (May 2019) in the hospital setting and suggested that most transmissions were associated with a ward converted to a COVID-19-dedicated ICU during the pandemic. All isolates were resistant to amphotericin B, voriconazole, and fluconazole at high-level, owing to mutations in ERG11(K143R) and TACB1(A640V). Present data demonstrated that the introduction of MDR C. auris in Italy was a recent event and suggested that its spread could have been facilitated by the COVID-19 pandemic. Continued efforts to implement stringent infection prevention and control strategies are warranted to limit the spread of this emerging pathogen within the healthcare system.

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“…Studies have shown that once C. auris is introduced into a healthcare facility, it spreads rapidly among susceptible patients [40,41]. Thus far, C. auris outbreaks have been reported from the United States of America [42][43][44][45], Canada [46], Mexico [47], the United Kingdom [48,49], Spain [50,51], India [40,52], Pakistan [53], Russia [54], Saudi Arabia [55], Oman [56,57], Kuwait [58], Kenya [59], South Africa [60], and Colombia [61]. Studies describing single/multiple invasive infections and outbreaks in different countries or geographical locations in the last several years have been extensively reviewed, only some of which are cited here [29][30][31][32]38].…”

Section: Epidemiology Of C Auris Infectionsmentioning

confidence: 99%

Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities

2021

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Candida auris, a recently recognized, often multidrug-resistant yeast, has become a significant fungal pathogen due to its ability to cause invasive infections and outbreaks in healthcare facilities which have been difficult to control and treat. The extraordinary abilities of C. auris to easily contaminate the environment around colonized patients and persist for long periods have recently resulted in major outbreaks in many countries. C. auris resists elimination by robust cleaning and other decontamination procedures, likely due to the formation of ‘dry’ biofilms. Susceptible hospitalized patients, particularly those with multiple comorbidities in intensive care settings, acquire C. auris rather easily from close contact with C. auris-infected patients, their environment, or the equipment used on colonized patients, often with fatal consequences. This review highlights the lessons learned from recent studies on the epidemiology, diagnosis, pathogenesis, susceptibility, and molecular basis of resistance to antifungal drugs and infection control measures to combat the spread of C. auris infections in healthcare facilities. Particular emphasis is given to interventions aiming to prevent new infections in healthcare facilities, including the screening of susceptible patients for colonization; the cleaning and decontamination of the environment, equipment, and colonized patients; and successful approaches to identify and treat infected patients, particularly during outbreaks.

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Outbreak of Candida auris infection in a COVID-19 hospital in Mexico

Cited by 151 publications

References 5 publications

Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs

Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs

Molecular Epidemiological Investigation of a Nosocomial Cluster of C. auris: Evidence of Recent Emergence in Italy and Ease of Transmission during the COVID-19 Pandemic

Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities

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