Clostridioides Difficile Infection before and during Coronavirus Disease 2019 Pandemic—Similarities and Differences

Kovacevic, Nadica; Petric, Vedrana; Pete, Maria; Popović, M.; Plećaš-Đurić, Aleksandra; Pejaković, Slađana; Tomić, Slavica; Damjanov, Dragomir; Kosijer, Dijana; Lekin, Milica

doi:10.3390/microorganisms10112284

Cited by 4 publications

(5 citation statements)

References 40 publications

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“…Malignancy was found to be more frequent in patients without COVID-19 which was also shown in Spain [ 25 ]. In contrast to our findings, a study conducted also in our county showed that chronic renal failure, malignancy, and chronic obstructive lung disease are more frequent in HA-CDI–COVID-19 patients than in HA-CDI patients without COVID-19 [ 32 ]. A possible explanation for these differences is that this study was conducted in two separate hospitals.…”

Section: Discussioncontrasting

confidence: 99%

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Incidence and Risk Factors for Clostridioides difficile Infections in Non-COVID and COVID-19 Patients: Experience from a Tertiary Care Hospital

et al. 2023

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(1) Background: The aim of this study was to assess the incidence and the risk factors for healthcare-associated Clostridioides difficile infection (HA-CDI) in patients with COVID-19 and without this infection. (2) Methods: A single-center, prospective observational study was conducted at the University Clinical Hospital Center in Belgrade, Serbia, from January 2019 to December 2021. The entire hospital was a COVID-dedicated hospital for 12 months during the study period. The incidence density rates and risk factors for HA-CDI in patients with and without COVID-19 are presented. (3) Results: The incidence rates of HA-CDIs were three times higher in patients with COVID-19. The HA-CDI–COVID-patients were younger (69.9 ± 12.6 vs. 72.5 ± 11.6; p = 0.017), admitted from another hospital (20.5% vs. 2.9; p < 0.001), had antimicrobial therapy before CDI (99.1% vs. 91.3%, p < 0.001), received two or more antibiotics (p = 0.030) during a longer period (p = 0.035), received proton pump inhibitors (95.9% vs. 50.0%, p < 0.001) during a longer period (p = 0.012) and steroids (32.8% vs. 20.4%, p < 0.001). During the last month before their current hospitalization, a higher percentage of patients without COVID-19 disease were hospitalized in our hospital (p < 0.001). Independent predictors for HA-CDIs in patients with COVID-19 were admission from another hospital (p = 0.003), the length of antibiotic administration (0.020), and the use of steroids in therapy (p < 0.001). The HA-CDI predictors in the non-COVID patients were older age (p = 0.017), advanced-stage renal failure (p = 0.005), chemotherapy (p = 0.003), and a low albumin level (0.005). (4) Conclusion: Higher incidence rates of HAI-CDIs in COVID-19 patients did not occur due to reduced infection control precautions and hygiene measures but due to antibiotic therapy and therapy with other drugs used during the pandemic.

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Section: Discussioncontrasting

confidence: 99%

“…In our study, steroid use was an independent risk factor for HA-CDI in COVID-19 patients. Similar results have been shown in a study conducted in other COVID and non-COVID hospitals in our country [ 32 ]. These drugs were part of many versions of protocols for the treatment of COVID-19 patients due to their anti-inflammatory role.…”

Section: Discussionsupporting

confidence: 92%

Incidence and Risk Factors for Clostridioides difficile Infections in Non-COVID and COVID-19 Patients: Experience from a Tertiary Care Hospital

et al. 2023

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“…Numerous other studies have shown that due to frequent hospitalisations and a greater number of comorbidities, people older than 65 years of age have a higher risk of developing infections caused by C difficile. 17,18 The basic mechanisms as to why CDI oc-curs more often and presents a more severe clinical manifestation in the elderly population, have not been sufficiently clarified. It is believed that several associated factors, such as comorbidities, polypharmacy and frequent hospitalisations may contribute to the observed outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Also, high CRP values in patients with HA -CDI may be a repercussion of the presence of more serious concomitant infections of other aetiology, which puts these patients at additional risk of a poor outcome of the disease. 17…”

Section: Discussionmentioning

confidence: 99%

Epidemiological and clinical characteristics of patients with healthcare: Associated Clostridioides difficile infection before and during the COVID-19 pandemic

Knežević¹,

Jović²,

Petković³

2023

Scripta Medica

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Background/Aim: Diarrhoea that occurs as a result of the presence of Clostridium difficile (reclassified as Clostridioides difficile) is usually manifested as a hospital infection, usually after antibiotic treatment. The study aim was to assess the incidence, characteristics and outcomes of hospitalised patients with healthcare - associated Clostridioides difficile infection (HA - CDI) before and during the COVID-19 pandemic. Methods: This retrospective cohort study included patients older than 18, who met the HA - CDI case definition. The CDI diagnosis was made by demonstrating toxins A and B in stool samples using an immunochromatographic assay test and polymerase chain reaction (PCR). Results: The incidence of HA - CDI has significantly decreased from the preCOVID-19 period to the COVID-19 period (11.04 per 10,000 vs 6.49 per 10,000, p < 0.001). Before establishing the HA - CDI diagnosis, 41.4 % of patients used one antibiotic, 25.9 % used two and 11.2 % were treated with three or more antibiotics. Almost one half of the applied antibiotics were from the group that represents high risk for the development of HA - CDI. Multivariable logistic regression analysis showed that older age (OR = 3.4; 95 % CI = 0.9-12.4; p = 0.038) and complicated disease course (OR = 11.8; 95 % CI = 2.6-53.6; p ≤ 0.001) were associated with a higher risk of death. Conclusion: The incidence of HA - CDI has decreased during the observed period of the COVID-19 pandemic, however, no clear connection between the impact of the pandemic and incidence reduction was found. Due to unfavourable outcome of the treatment of HA - CDI patients during COVID-19 pandemic, the rational use of antibiotics is necessary.

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“…It is logical to suppose that hospitalised patients have disrupted gut microbiota and this will increase the number of CDIs, but on the contrary, a strong decrease in C. difficile incidence was observed, likely due to improvements in hand hygiene, use of personal protective equipment, and environmental cleaning in the healthcare settings [124]. However, the COVID pandemic has had a big influence; a recent study showed that COVID-19 changed the CDI patterns with a significantly greater percentage of a lethal outcome, 29.5% vs 6.6% [125]. Another study from Canada for 2020/2021 reported an increased frequency of CDIs [126].…”

Section: Treatmentmentioning

confidence: 99%

Clostridioides difficile, a New “Superbug”

et al. 2023

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Clostridioides difficile is a Gram-positive, spore-forming, anaerobic bacterium. The clinical features of C. difficile infections (CDIs) can vary, ranging from the asymptomatic carriage and mild self-limiting diarrhoea to severe and sometimes fatal pseudomembranous colitis. C. difficile infections (CDIs) are associated with disruption of the gut microbiota caused by antimicrobial agents. The infections are predominantly hospital-acquired, but in the last decades, the CDI patterns have changed. Their prevalence increased, and the proportion of community-acquired CDIs has also increased. This can be associated with the appearance of hypervirulent epidemic isolates of ribotype 027. The COVID-19 pandemic and the associated antibiotic overuse could additionally change the patterns of infections. Treatment of CDIs is a challenge, with only three appropriate antibiotics for use. The wide distribution of C. difficile spores in hospital environments, chronic persistence in some individuals, especially children, and the recent detection of C. difficile in domestic pets can furthermore worsen the situation. “Superbugs” are microorganisms that are both highly virulent and resistant to antibiotics. The aim of this review article is to characterise C. difficile as a new member of the “superbug” family. Due to its worldwide spread, the lack of many treatment options and the high rates of both recurrence and mortality, C. difficile has emerged as a major concern for the healthcare system.

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Clostridioides Difficile Infection before and during Coronavirus Disease 2019 Pandemic—Similarities and Differences

Cited by 4 publications

References 40 publications

Incidence and Risk Factors for Clostridioides difficile Infections in Non-COVID and COVID-19 Patients: Experience from a Tertiary Care Hospital

Incidence and Risk Factors for Clostridioides difficile Infections in Non-COVID and COVID-19 Patients: Experience from a Tertiary Care Hospital

Epidemiological and clinical characteristics of patients with healthcare: Associated Clostridioides difficile infection before and during the COVID-19 pandemic

Clostridioides difficile, a New “Superbug”

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