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Cited by 22Antifungal resistance and susceptibilityInfection Control in HealthcareNosocomial Infections in ICU

An overview of healthcare-associated Candida auris outbreaks in Ministry of Health hospitals-Saudi Arabia 2020-2022; retrospective multicentric study

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Alanazi, Khalid H., Roushdy, Hala M., ALzubaidi, Waad I., Alanazi, Arwa S., Alanazi, Nawal M., Alamri, Ahlam H., Alnshbah, Yahya I., AL Almatrafi, Nawaf M. +3 more·2025·PLOS ONE
DOI 10.1371/journal.pone.0313589PMC PMC11698452
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Abstract

Background: Candida auris (C. auris) is an emerging fungus pathogen associated with nosocomial infections that is seen as a serious global health issue. Aim: To describe the epidemiology and features of hospital-acquired Candida auris outbreaks in the Ministry of Health hospitals (MOH). Methods: A three-year (2020–2022) retrospective analysis of Candida auris outbreaks in the Saudi MOH hospitals. A total of 45 hospitals were involved, with 511 cases of Candida auris . The data collected from the General Directorate of Infection Prevention and Control (GDIPC) platform comprises all patients’ data for C . auris instances, whether infected or colonized. Results: Out of the 511 Candida auris recruited cases, 291 (56.9%) were infected, whereas 220 (43.1%) were colonized. 32.9% of cases were above the age of 65, and 68.9% were male. The majority of cases were admitted in the ICU unit (95.5%). Approximately 18.8% of cases were diabetes, and 18.5% were hypertensive. Central lines were discovered in 37.7% of the cases. Approximately 85.9% of cases had Foley catheters, 68.5% were on ventilators, and 53.8% had a tracheostomy. The crude mortality rate was particularly high (41.5%) among the study cases. It was non-significantly higher among infected individuals (44.7%) than colonized patients (37.3%) at ( p value = 0.093). The prevalence of hypertension (p = 0.001), DM (p = 0.003), and peripheral line insertion (p = 0.004) was significantly higher among colonized patients. While the presence of COVID-19 (p = 0.001), and central line insertion (p = 0.001) was significantly higher among infected patients. Conclusion: C . auris is a new pathogen that causes hospital outbreaks. Strict adherence to infection prevention and control criteria established by the Centre for Disease Control (CDC) and GDPIC has significantly contained and reduced the spread of these outbreaks. One-month retrospective surveillance before diagnosing the index case and a prospective surveillance strategy for at least three months is highly recommended.

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  • Diabetes has been repeatedly associated with an increased risk of C. auris systemic infection.

    “diabetes has also been repeatedly associated with an increased risk of C. auris systemic infection [15,40–43].”

    From Host–Candida auris interactions in the skin (2026) · cites this paper as [41]

    The Background lists diabetes as a risk factor for C. auris acquisition generally, but does not establish a repeated association with systemic infection. In the Results (Table 3; page unavailable), diabetes was significantly more common among colonized patients than infected patients—the opposite direction for the paper’s infection-versus-colonization comparison. (LLM, conf=0.86)

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  • C. auris skin colonization frequently occurs in patients recently exposed to prolonged courses of broad-spectrum antibiotics, particularly carbapenems and vancomycin, with 43.3% of colonized patients treated with carbapenems, and 41.7% with vancomycin.

    “C. auris skin colonization frequently occurs in patients recently exposed to prolonged courses of broad-spectrum antibiotics, particularly carbapenems and vancomycin, with 43.3% of colonized patients treated with carbapenems, and 41.7% with vancomycin [40–43,45–47].”

    From Host–Candida auris interactions in the skin (2026) · cites this paper as [41]

    The Background identifies prolonged broad-spectrum antibiotic exposure as a risk factor for C. auris acquisition, and the Results report antibiotic exposure in 85.3% of all 511 cases, including both infected and colonized patients. The paper does not report exposure specifically to carbapenems or vancomycin, the claimed 43.3% and 41.7% figures, or prolonged antibiotic courses specifically among skin-colonized patients. (LLM, conf=0.88)

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Cites

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Research works printed but not linked: 22

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Cited by

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Authors
Alanazi, K. H., Roushdy, H. M., ALzubaidi, W. I., Alanazi, A. S., Alanazi, N. M., Alamri, A. H., Alnshbah, Y. I., AL Almatrafi, N. M., Al Shahrani, Z. M., Alanazi, A. S., & Alshanbari, N. H.
Affiliations
Ministry of Health (SA)
Corresponding author
Roushdy, Hala M.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2025-01-03
Volume
20
Issue
1
Pages
e0313589
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0313589
PMC
PMC11698452
OpenAlex
W4406051985
Cited by
22
References
3
Citations by year
2026: 18 · 2025: 4
FWCI
16.93
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords
Candida auris, hospital outbreak, nosocomial fungal infections, candidemia, fungal colonization, risk factors, intensive care unit, central venous catheters, COVID-19 pandemic, mortality, infection control, Saudi Arabia, Ministry of Health hospitals, risk stratification
MeSH terms
Candida auris, Adult, Aged, Aged, 80 and over, Candidiasis, Cross Infection, Disease Outbreaks, Female, Hospitals, Humans, Intensive Care Units, Male, Middle Aged, Retrospective Studies, Saudi Arabia, Young Adult, Candidiasis, Invasive

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