The other ‘C’: Hospital-acquired <i>Clostridioides difficile</i> infection during the coronavirus disease 2019 (COVID-19) pandemic

Hazel, Karl; Skally, Máiréad; Glynn, Emily; Foley, Margaret; Burns, Karen; O’Toole, Aoibhlinn; Boland, Karen; Fitzpatrick, Fidelma

doi:10.1017/ice.2021.3

Cited by 27 publications

(32 citation statements)

References 8 publications

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“…Its impact on the healthcare system should not be considered only in the short term by affecting patient’s status, medical workers [ 41 ] and the fact that some diseases might be neglected but also in the long-run by the use of specific medication and their effect on patients [ 42 ]. However, at first, the CDI rate might be on a lower trend, due to increase hand hygiene and contact precautions, but most of all due to extensive cleaning and general disinfection, along with more patients which develop severe disease, as antibiotics will be used more frequently to prevent additional bacterial pulmonary infection [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

et al. 2021

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Clostridioides difficile infection (CDI) stands as the leading cause of nosocomial infection with high morbidity and mortality rates, causing a major burden on the healthcare system. Driven by antibiotics, it usually affects older patients with chronic disease or immunosuppressed or oncologic management. Variceal bleeding secondary to cirrhosis requires antibiotics to prevent bacterial translocation, and thus patients become susceptible to CDI. We aimed to investigate the risk factors for CDI in cirrhotic patients with variceal bleeding following ceftriaxone and the mortality risk in this patient’s population. We retrospectively screened 367 cirrhotic patients with variceal bleeding, from which 25 patients were confirmed with CDI, from 1 January 2017 to 31 December 2019. We found MELD to be the only multivariate predictor for mortality (odds ratio, OR = 1.281, 95% confidence interval, CI: 0.098–1.643, p = 0.042). A model of four predictors (age, days of admission, Charlson index, Child–Pugh score) was generated (area under the receiver operating characteristics curve, AUC = 0.840, 95% CI: 0.758–0.921, p < 0.0001) to assess the risk of CDI exposure. Determining the probability of getting CDI for cirrhotic patients with variceal bleeding could be a tool for doctors in taking decisions, which could be integrated in sustainable public health programs.

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Section: Discussionmentioning

confidence: 99%

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

et al. 2021

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“…Infections caused by C. difficile during the COVID-19 pandemic have been investigated by many authors [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 21 ]. Some, for example, Allegretti et al [ 9 ] and Hazel et al [ 21 ], reported lower rates of CDI, attributing them to the implementation of strict hygiene precautions as well as to the isolation of patients with CDI, which was impossible in our department during the COVID-19 pandemic. A study by Lewandowski et al [ 11 ] is one of few to describe a significant increase in CDI, stressing that the disease may be underdiagnosed.…”

Section: Discussionmentioning

confidence: 99%

Clostridioides difficile and Vancomycin-Resistant Enterococci in COVID-19 Patients with Severe Pneumonia

Bogdanová

Doubravská

Vágnerová

et al. 2021

Life

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Broad-spectrum antibiotics administered to patients with severe COVID-19 pneumonia pose a risk of infection caused by Clostridioides difficile. This risk is reduced mainly by strict hygiene measures and early de-escalation of antibiotic therapy. Recently, oral vancomycin prophylaxis (OVP) has also been discussed. This retrospective study aimed to assess the prevalence of C. difficile in critical COVID-19 patients staying in an intensive care unit of a tertiary hospital department of anesthesiology, resuscitation, and intensive care from November 2020 to May 2021 and the rates of vancomycin-resistant enterococci (VRE) after the introduction of OVP and to compare the data with those from controls in the pre-pandemic period (November 2018 to May 2019). During the COVID-19 pandemic, there was a significant increase in toxigenic C. difficile rates to 12.4% of patients, as compared with 1.6% in controls. The peak rates were noted in February 2021 (25% of patients), immediately followed by initiation of OVP, changes to hygiene precautions, and more rapid de-escalation of antibiotic therapy. Subsequently, toxigenic C. difficile detection rates started to fall. There was a nonsignificant increase in VRE detected in non-gastrointestinal tract samples to 8.9% in the COVID-19 group, as compared to 5.3% in the control group. Molecular analysis confirmed mainly clonal spread of VRE.

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“…Among them, one important aspect has been improved infection prevention measures such as higher compliance in hand hygiene and isolation precautions. 74,76 Only one small study specifically commented on CA-CDI versus HA-CDI, finding that six out of 38 CDI cases were community-onset, and two out of 38 were rCDI. 76 In that study, COVID-19 patients with CDI had worse outcome than those without CDI, including longer hospital stay (35 days versus 19.4 days, p < 0.01) and lower rates of full recovery without complications (50% versus 64.9%, p = 0.01).…”

Section: Covid-19 and CDImentioning

confidence: 99%

“…72,73 In some centers, there has been a reduction in HA-CDI cases. 74,75 Multiple factors potentially contributed to the decrease. Among them, one important aspect has been improved infection prevention measures such as higher compliance in hand hygiene and isolation precautions.…”

Section: Covid-19 and CDImentioning

confidence: 99%

Epidemiology of community-acquired and recurrent Clostridioides difficile infection

Luo

Grinspan

2021

Therap Adv Gastroenterol

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Clostridioides difficile infection is a leading cause of healthcare-associated infections with significant morbidity and mortality. For the past decade, the bulk of infection prevention and epidemiologic surveillance efforts have been directed toward mitigating hospital-acquired C. difficile. However, the incidence of community-associated infection is on the rise. Patients with community-associated C. difficile tend to be younger and have lower mortality rate. Rates of recurrent C. difficile infection overall have decreased in the United States, but future research and public health endeavors are needed to standardize and improve disease detection, stratify risk factors in large-scale population studies, and to identify regional and local variations in strain types, reservoirs and transmission routes to help characterize and combat the changing epidemiology of C. difficile.

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The other ‘C’: Hospital-acquired Clostridioides difficile infection during the coronavirus disease 2019 (COVID-19) pandemic

Cited by 27 publications

References 8 publications

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

Clostridioides difficile and Vancomycin-Resistant Enterococci in COVID-19 Patients with Severe Pneumonia

Epidemiology of community-acquired and recurrent Clostridioides difficile infection

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