Objectives: The coronavirus disease 2019 (COVID-19) pandemic has induced a reinforcement of infection control measures in the hospital setting. Here, we assess the impact of the COVID-19 pandemic on the incidence of nosocomial Clostridioides difficile infection (CDI). Methods: We retrospectively compared the incidence density (cases/10,000 patient-days) of healthcare facility-associated (HCFA) CDI in a tertiary hospital in Madrid (Spain) during the maximum incidence of COVID-19 (11 March to 11 May 2020) with the same period of the previous year (control period). We also assessed the aggregate in-hospital antibiotic use (defined daily doses [DDD] per 100 occupied bed-days [BD]) and incidence density (movements/1000 patient-days) of patient mobility during both periods. Results: A total of 2337 patients with reverse transcription-polymerase chain reaction-confirmed COVID-19 were admitted to the hospital during the COVID-19 period. Twelve HCFA CDI cases were reported at this time (incidence density of 2.68/10,000 patient-days), whereas 34 HCFA CDI cases were identified during the control period (incidence density 8.54/10,000 patient-days) (P=.000257). Antibiotic consumption was slightly higher during COVID-19 (89.73 DDD/100 BD) than during the control period (79.16 DDD/100 BD). The incidence density of patient movements was 587.61/1000 patient-days during the control period and significantly lower during the COVID-19 period (300.86/1000 patient-days) (P<.0001). Conclusions: The observed reduction of approximately 70% in the incidence density of HCFA CDI in a context of no reduction in antibiotic use supports the importance of reducing nosocomial transmission by healthcare workers and asymptomatic colonised patients, reinforcing cleaning procedures and reducing patient mobility in the epidemiological control of CDI.

EN in critically ill patients with severe hypoxemia receiving mechanical ventilation in PP is feasible, safe, and not associated with an increased risk of gastrointestinal complications. Larger studies are needed to confirm these findings.

The MRCI-E retains the reliability and validity of the original index and provides a suitable tool to assess the complexity of medication regimens in Spanish.

Before the intervention, the frequency of appropriate prescribing based on renal function was 65 %. After the intervention, this frequency was 86 % (p < 0.001). The interventions were more frequent in the emergency department (45 %). The program required 30-45 min of pharmacist time per day. The average number of patients reviewed daily was 28. This study found that a computer-based, semi-automated drug-dosage program for renal failure patients was able to reduce the number of inappropriate orders due to renal insufficiency.