Clostridioides difficile infection epidemiology and clinical characteristics in COVID-19 pandemic

Abstract

Information on Clostridioides difficile infection (CDI) in patients with COVID-19 is scarce and points to an overall decrease of episodes during the pandemic. This situation results paradoxical, as COVID-19 patients had long periods of hospital stay and high use of antibiotics. We conducted a retrospective study from January 1st 2019 to December 31st 2020 comparing the incidence of hospital-acquired episodes of CDI (HA-CDI) among patients with and without COVID-19 admitted to our institution. During the study period, there were 47,048 patient admissions in 2019, 35,662 admissions of patients without COVID-19 in 2020 and 6,763 of COVID-19 patients. There were 68 episodes of HA-CDI in COVID-19 patients (14.75/10,000 days), 159 in 2020-non-COVID-19 patients (5.54/10,000 days) and 238 in 2019 (6.80/10,000 days). Comparison of HA-CDI in COVID-19 and non-COVID-19 patients indicates it occurs more frequently, in terms of CDI disease severity, COVID-19 does not seem to have a negative impact.

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

“…An analysis of the demographic characteristics of our patients showed results similar to the majority of previous studies, in which the largest number of CDI patients were of older age [6,17,19]. In our study, patients with CDI/COVID-19 coinfection were older compared to CDI patients in the prepandemic period, 72.8 ± 9.4 vs. 65.6 ± 11.7 (p ≤ 0.001).…”

“…Such results could be interpreted by the fact that, during the COVID-19 pandemic, this viral infection was more common in men. Nevertheless, the research conducted by Vasquez-Cueste et al did not register a significant difference in gender between the studied groups of patients [19].…”

“…This trend can partially be explained by the decreased function of the immune system, which is why most people of this age are considered immunocompromised, to have a decrease in the gastric acidity, a decrease in the protective function of bifidobacteria in the intestinal tract and have more frequent exposure to C. difficile due to repeated hospitalizations and multiple comorbid conditions. The clinical and epidemiological significance of the development of CDI in the elderly population is today reflected in the increasingly frequent occurrence of recurrent forms of the disease, poorer response to therapy, and an increase in the number of complications and mortality rate [17][18][19]. In some studies, the age structure of patients did not differ in the pandemic and prepandemic period [17].…”

“…Changes in the epidemiological, immunological, and clinical picture in recent years have made the CDI of today different from the CDI of the past [6,18,19]. Continuous exposure to antibiotics has caused CD to develop into a multidrug-resistant (MDR) pathogen with increasing virulence, and around 60% of clinical CD strains are already reported as MDR in European hospitals [5,20].…”

“…Continuous exposure to antibiotics has caused CD to develop into a multidrug-resistant (MDR) pathogen with increasing virulence, and around 60% of clinical CD strains are already reported as MDR in European hospitals [5,20]. For the abovementioned reasons, CDI is today considered one of the most important nosocomial infections worldwide and one of the most important threats to global health [6,18,19]. Increasingly, C. difficile infections demonstrate an emerging pattern of resistance to available treatment and recurrence after an initial episode [21].…”