Examining the Rate of Clostridioides (Formerly Clostridium) Difficile Infection Pre- and Post-COVID-19 Pandemic: An Institutional Review

Abstract

Background/ RationaleClostridioides difficile infection (CDI) is transmitted via the fecal-oral route and is implicated in antibioticassociated colitis. Similar to CDI, patients with coronavirus disease 2019 (COVID-19) require early identification and isolation, appropriate personal protective equipment, and environmental disinfection to prevent further transmission. In light of this similarity between isolation and protective requirements to prevent transmission of these diseases, we aim to investigate whether there was a decrease in the incidence of CDI during the peak periods of the COVID-19 pandemic compared to historical rates. MethodsThis is a single-center retrospective analysis of the rates of CDI in our institution. COVID-19 time periods were identified from March 2020 to January 2021 and peak periods (with >50 active patients per day) were defined. The non-COVID-19 periods were July 2017 to February 2020. Rates of CDI were also directly compared across the yearly time period. CDI rates were presented in a per 1000 patient days format. Rates were analyzed per year and during the COVID-19 peaks at our institution. Mann-Whitney U test was used to compare rates between two time periods, while differences across multiple time intervals were analyzed using the Kruskal-Wallis test. ResultsThe median (interquartile range [IQR]) of CDI rates of infection per 1000 patient days for the non-COVID time period from July 2017 to February 2020 was 0.34 (0.23-0.45) while COVID time periods had higher 0.44 (0.25-0.51) rates of CDI although this was not statistically significant (p=0.224). However, there was a statistically significant difference (p=0.036) with COVID peak periods having higher rates of CDI 0.49(0.39-0.74) vs 0.34(0.23-0.44). Overall, there was no statistically significant difference in the rates of CDI across years or time periods (p=0.396). Discussion/ConclusionThere was no difference in the rates of hospital-acquired CDI between COVID-19 and non-COVID-19 time periods at our institution.

The Impact of Clostridioides Difficile Infection in Hospitalized Patients: What Changed during the Pandemic?

“…Yadlapati et al noticed slightly higher CDI rates in COVID periods compared to the non-COVID period, but without statistical significance. Significantly higher CDI rates were detected during COVID peak periods, potentially due to increased antibiotic prescription [ 38 ]. Other authors pointed to the impact of CDI during the pandemic.…”

Clostridium difficile Infection Rates During the Pandemic in New York Capital Area: A Single-Center Study

“…Another retrospective analysis, investigating the COVID-19 era until January 2021, identified higher CDI rates during COVID-19 peak periods [18]. Moreover, there were studies that despite not revealing any changes in CDI incidence, describe an increase in severe CDI cases [19].…”

“…A recent large Canadian study involving multiple centers revealed an 11% increase in hospital-acquired CDI during the pandemic [ 8 ]. Another retrospective analysis, investigating the COVID-19 era until January 2021, identified higher CDI rates during COVID-19 peak periods [ 18 ]. Moreover, there were studies that despite not revealing any changes in CDI incidence, describe an increase in severe CDI cases [ 19 ].…”

Trends in Clostridioides difficile infection rates in Canadian hospitals during the coronavirus disease 2019 (COVID-19) pandemic

“…1 Single-center studies have reported increased, 2 decreased, 3,4 or unchanged CDI rates. 5,6 Furthermore, the impact of the COVID-19 pandemic on rates of CDI in Canada has not yet been described. Using national surveillance data, we compared CDI rates, patient characteristics, and clinical outcomes before and during the COVID-19 pandemic in Canada.…”