In a Epidemiological Alert from the Pan American Health Organization (PAHO) published this weekend, they document the increase of healthcare-associated Candida auris outbreaks in the Region of the Americas and in the context of the COVID-19 pandemic.

Image/CDC

They write that in 2020, seven countries documented cases of C. auris, for the most part, in patients with a history of COVID-19 infection: Brazil, Guatemala, Mexico, Peru, Panama, Colombia, and the United States (the first four reported their first isolates during this time).

In December 2020, Brazil officials reported the first C. auris isolate in the country, in a healthcare facility in the state of Bahia. The isolate was recovered from the catheter tip of a hospitalized intensive care unit (ICU) patient with complications from COVID-19.

Before the end of the year, two other cases had been confirmed in hospitalized patients (one positive
for C. auris on the catheter tip and the other positive for C. auris in blood culture). The outbreak investigation subsequently found extensive colonization of patients and environmental contamination by C. auris.

Also in December, Guatemala reported a case d in soft tissue and bone biopsies from a patient diagnosed with acute osteomyelitis of the right tibia. In addition, a second case, from the same general surgery service, was recovered from a leg tissue biopsy of a multiple trauma patient with a surgical site infection.

Mexico reported its first C. auris case in May last year in the state of Nuevo León, in the blood cultures of a non-COVID patient with severe endometriosis. Three months later, while the hospital was transitioning from general care to exclusively caring for COVID-19 patients, 34 colonizations and an outbreak of C. auris were identified, involving 10 ICU patients. These isolates were obtained from the bloodstream and urine. All infected patients had a history of COVID-19 pneumonia, ICU hospitalization, mechanical ventilation, urinary catheter, central venous catheter, prolonged stay, and antibiotic therapy.

In late 2020, Peru reported the confirmation of C. auris in two patients at a public hospital in Lima, both
with respiratory ailments (latent tuberculosis in the first and COVID-19 in the second).

In Panama, since the beginning of the pandemic, 124 C. auris isolates have been identified, of which 108 correspond to patients diagnosed with COVID-19.

In Colombia, during the year 2020, 585 cases of C. auris were reported, of which 37 occurred in patients hospitalized with SARS-CoV-2 infections.

In the United States, in July 2020, the Health Department of the State of Florida, United States, was alerted to a C. auris outbreak that involved three bloodstream infections and one urinary tract infection, in four hospitalized COVID-19 patients. An investigation was then carried out to identify colonized patients. Of the 67 patients admitted to the COVID-19 unit and tested, 35 (52%) had positive cultures. The average age of the colonized patients was 69 years (range = 38-101 years) and 60% were male. Six (17%) colonized patients subsequently developed C. auris infection.

The appearance and subsequent worldwide spread of the SARS-CoV-2 virus has presented a great challenge for health systems, overloading their capacity. Intensive care unit, with patients who have the greatest risk factors for C. auris infection, have been the most affected.