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

Boeriu, Alina; Roman, Adina; Dobru, Daniela; Stoian, M; Voidăzan, Septimiu; Fofiu, Crina

doi:10.3390/diagnostics12123196

Cited by 9 publications

(9 citation statements)

References 76 publications

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“…These findings are consistent with previous studies that have shown a higher incidence of CDI in COVID-19 patients compared to non-COVID-19 patients [ 13 , 14 ]. In a study by Boeriu et al, CDI incidence was significantly higher in COVID-19 patients, and the study identified several risk factors for CDI in COVID-19 patients, including advanced age, antibiotic use, and proton pump inhibitor (PPI) use [ 13 ].…”

Section: Discussionsupporting

confidence: 93%

Clostridioides difficile Infection in COVID-19 Hospitalized Patients: A Nationwide Analysis

Deda,

Elfert,

Gandhi

et al. 2023

Gastroenterol Res

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Background Clostridioides difficile infection (CDI) is a significant healthcare-associated infection with implications for patient morbidity, mortality, and healthcare costs. However, the connection between CDI and coronavirus disease 2019 (COVID-19) infection and its influence on patient outcomes remain uncertain. This study aimed to examine the association between CDI and COVID-19, specifically investigating whether CDI worsens outcomes in patients with COVID-19. By utilizing the extensive National Inpatient Sample (NIS) database and analyzing pertinent factors, this research endeavored to enhance our understanding of CDI within the context of COVID-19. Methods The NIS database was searched for adult patients hospitalized with a primary diagnosis of COVID-19 infection in 2020. Patients with a secondary diagnosis of CDI were identified and separated into two groups based on CDI status. Baseline characteristics, Charlson Comorbidity Index (CCI), and outcomes were compared between the two groups using Chi-square and t -tests. Multivariate logistic and linear regressions were performed for the identification of independent predictors of CDI and mortality. Results A total of 1,045,125 COVID-19 hospitalizations were included, of which 4,920 had a secondary diagnosis of CDI. Patients with CDI and COVID-19 were older (mean age 69.9 vs. 64.2 years; P < 0.001), more likely to be female (54.1% vs. 47.1%; P < 0.001) and white (60% vs. 52.4%; P < 0.001). The CDI and COVID-19 group had a longer length of stay (14.1 vs. 7.42 days; P < 0.001), higher total hospital costs ($42,336 vs. $18,974; P < 0.001), and higher inpatient mortality (21.6% vs. 11%; P < 0.001) compared to the COVID-19 group without CDI. Patients in the CDI and COVID-19 group had a higher CCI score (51.7% with a score of 3 or more vs. 27.7%; P < 0.001), indicating a higher comorbidity burden. Multivariate logistic regression analysis revealed CDI was independently associated with increased mortality (odds ratio (OR) 1.37; P = 0.001) and showed that the female gender and several pre-existing comorbidities were associated with a higher likelihood of CDI. Conclusion CDI is independently associated with increased mortality in patients admitted with COVID-19 infection. Female gender and several pre-existing comorbidities are independent predictors of CDI in COVID-19 patients.

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Section: Discussionsupporting

confidence: 93%

Clostridioides difficile Infection in COVID-19 Hospitalized Patients: A Nationwide Analysis

Deda,

Elfert,

Gandhi

et al. 2023

Gastroenterol Res

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“…Creatinine and CRP were singled out as independent predictors of a severe form of CDI and were attributed to mortality in patients with CDI before the start of the pandemic [ 43 ]. Although a negative impact of associated CDI and COVID-19 on patient outcomes was found [ 45 ], we did not find a difference in outcomes between COVID and non-–COVID HA-CDI patients. Our results are in concordance with those from Spain [ 25 ].…”

Section: Discussioncontrasting

confidence: 85%

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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“…The antibiotics most commonly associated with CDI are aminopenicillins, second and third-generation cephalosporins, fluoroquinolones, and clindamycin, which have seen an increase in their use in recent years [9]. The pathogenic power of CD is linked to its ability to produce two enterotoxins, TcdA and TcdB [13], which cause intestinal damage by activating an inflammatory cellular response with mild clinical manifestations ranging from asymptomatic colonization or mild and self-limiting diarrhea to more severe manifestations ranging from pseudomembranous colitis, which can lead to acute intestinal insufficiency with toxic megacolon, intestinal perforation, septic shock, disseminated intravascular coagulation (DIC), and death [14,15].…”

Section: General Characteristicsmentioning

confidence: 99%

“…CDI is a bacterial infection that primarily affects the colon and causes symptoms ranging from mild diarrhea to severe life-threatening conditions [14,15]. Clustering CDI involves grouping cases of the infection based on various factors to gain insights into its epidemiology, risk factors, and potential treatment approaches.…”

Section: Clostridioides Difficile Infection From the Perspective Of C...mentioning

confidence: 99%

Clustering Disease of Clostridioides Difficile Infection: Implication for the Management in Internal Medicine

Crispino

2023

Microbiology Research

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Clostridioides difficile is a bacterium responsible for a healthcare-associated gastrointestinal infection, primarily affecting people who have undergone prolonged antibiotic treatment or who have compromised immune systems. The CD is of particular concern due to its high recurrence rates and the potential for serious outcomes, including life-threatening conditions such as pseudomembranous colitis, septic shock, and all associated conditions. Since this infection is a disease associated with other health conditions, a general vision of the problems is necessary which aims to obtain a general overview of the manifestations that generally correlate with care. Clinical reasoning following the disease-clustering method is able to produce a categorization process by grouping the possible correlations of the various conditions or factors underlying diseases on the basis of certain similarities or common models. The clustering process is performed using data analysis techniques which, by statically correlating each other, give an exact dimension of all the information related to a particular disease. In the case of CD, reasoning based on disease clustering has better clarified the practices, appropriateness in infection control, judicious use of antibiotics, and research into therapeutic and preventive strategies. This review, taking advantage of the clustering strategy, aimed to analyze the contingent conditions of the infection under examination, to reduce the incidence and impact of CD, having as its mission the improvement of the results deriving from the contrast of all those correlated pathological conditions to healthcare for the improvement of public health.

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

Cited by 9 publications

References 76 publications

Clostridioides difficile Infection in COVID-19 Hospitalized Patients: A Nationwide Analysis

Clostridioides difficile Infection in COVID-19 Hospitalized Patients: A Nationwide Analysis

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

Clustering Disease of Clostridioides Difficile Infection: Implication for the Management in Internal Medicine

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