How Does COVID-19 Pandemic Impact on Incidence of Clostridioides difficile Infection and Exacerbation of Its Gastrointestinal Symptoms?

Abstract

Coronavirus disease 2019 (COVID-19) has rapidly spread all over the world with a very high rate of mortality. Different symptoms developed by COVID-19 infection and its impacts on various organs of the human body have highlighted the importance of both coinfections and superinfections with other pathogens. The gastrointestinal (GI) tract is vulnerable to infection with COVID-19 and can be exploited as an alternative transmission route and target for virus entry and pathogenesis. The GI manifestations of COVID-19 disease are associated with severe disease outcomes and death in all age groups, in particular, elderly patients. Empiric antibiotic treatments for microbial infections in hospitalized patients with COVID-19 in addition to experimental antiviral and immunomodulatory drugs may increase the risk of antibiotic-associated diarrhea (AAD) and Clostridioides difficile infection (CDI). Alterations of gut microbiota are associated with depletion of beneficial commensals and enrichment of opportunistic pathogens such as C. difficile. Hence, the main purpose of this review is to explain the likely risk factors contributing to higher incidence of CDI in patients with COVID-19. In addition to lung involvement, common symptoms observed in COVID-19 and CDI such as diarrhea, highlight the significance of bacterial infections in COVID-19 patients. In particular, hospitalized elderly patients who are receiving antibiotics might be more prone to CDI. Indeed, widespread use of broad-spectrum antibiotics such as clindamycin, cephalosporins, penicillin, and fluoroquinolones can affect the composition and function of the gut microbiota of patients with COVID-19, leading to reduced colonization resistance capacity against opportunistic pathogens such as C. difficile, and subsequently develop CDI. Moreover, patients with CDI possibly may have facilitated the persistence of SARS-CoV-2 viral particles in their feces for approximately one month, even though the nasopharyngeal test turned negative. This coinfection may increase the potential transmissibility of both SARS-CoV-2 and C. difficile by fecal materials. Also, CDI can complicate the outcome of COVID-19 patients, especially in the presence of comorbidities or for those patients with prior exposure to the healthcare setting. Finally, physicians should remain vigilant for possible SARS-CoV-2 and CDI coinfection during the ongoing COVID-19 pandemic and the excessive use of antimicrobials and biocides.

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

“…It is found in the oral and nasal mucosa, nasopharynx, lungs, kidneys, brain, heart, spleen, liver, stomach, small intestine, colon, lymph nodes, thymus, and bone marrow. The SARS-CoV-2 virus mostly binds to ACE2 receptors in alveolar epithelial cells of the lungs, as well as endothelial and muscle cells of arteries and veins in all organs [1,2]. Apart from respiratory symptoms, which are the most common, some patients (2-50%) also have diarrhea as part of the clinical presentation [3].…”

Application of recombinant antibodies for treatment of Clostridioides difficile infection: Current status and future perspective

“…Normally, the bacterium is transmitted by shedding the spores in the environment and it can colonize the gastrointestinal (GI) tract of the infected patients where all of the aspects of C. difficile physiology are supported ( 4 , 5 ). Currently, C. difficile infection (CDI) is known as the leading cause of nosocomial diseases associated with antibiotic therapy and healthcare-associated diarrhea in adults ( 6 – 8 ). CDI is characterized by neutrophil accumulation and appearance of distinct plaques (pseudomembranes) in the intestinal lumen ( 9 , 10 ).…”

Profile of Secondary Bacterial and Fungal Infections in Hospitalized COVID-19 Patients in a Tertiary Care Centre

“…A significant observation in hospitalized COVID-19 patients was the alteration in the fecal microbiota leading to subsequent colonization and infections with opportunistic pathogens. 4 The immunosuppression seen in the course of this viral infection predisposes the individual to a variety of bacterial infections. Bacterial infections severely affect the outcome in these patients.…”

“…A significant observation in hospitalized COVID-19 patients was the alteration in the fecal microbiota leading to subsequent colonization and infections with opportunistic pathogens. 4 …”