Aim: To assess the impact of Clostridioides difficile infection on the course of COVID-19. Methods: The authors included 809 patients with COVID-19 in this retrospective study: 55 had C. difficile infection, 23 had C. difficile-negative antibiotic-associated diarrhea and 731 had no diarrhea. C. difficile in feces was determined by immunochromatographic test for its toxins. Results: C. difficile infection was associated with increased risk of death (hazard ratio = 2.6; p = 0.021), especially after 20 days of disease (hazard ratio = 6.5; p < 0.001). C. difficile infection-associated diarrhea was longer and more severe than C. difficile-negative antibiotic-associated diarrhea. Unlike patients with C. difficile-negative antibiotic-associated diarrhea, patients with C. difficile infection were admitted to the intensive care unit and needed mechanical ventilation more often than those without diarrhea. Conclusion: C. difficile infection worsens the course and prognosis of COVID-19.

Diarrhea is one of the manifestations of the novel coronavirus disease , but it also develops as a complication of massive antibiotic therapy in this disease. This study aimed to compare these types of diarrhea.We included patients with COVID-19 in a cohort study and excluded patients with chronic diarrhea, laxative use, and those who died during the first day of hospitalization.There were 89 (9.3%), 161 (16.7%), and 731 (75.7%) patients with early viral, late antibiotic-associated, and without diarrhea, respectively. Late diarrhea lasted longer (6 [4-10] vs 5 [3-7] days, P < .001) and was more severe. Clostridioides difficile was found in 70.5% of tested patients with late diarrhea and in none with early diarrhea. Presence of late diarrhea was associated with an increased risk of death after 20 days of disease (P = .009; hazard ratio = 4.7). Patients with late diarrhea had a longer hospital stay and total disease duration, and a higher proportion of these patients required intensive care unit admission. Oral amoxicillin/clavulanate (odds ratio [OR] = 2.23), oral clarithromycin (OR = 3.79), and glucocorticoids (OR = 4.41) use was a risk factor for the development of late diarrhea, while ceftriaxone use (OR = 0.35) had a protective effect. Before the development of late diarrhea, decrease in C-reactive protein levels and increase in lymphocyte count stopped but the white blood cell and neutrophil count increased. An increase in neutrophils by >0.6 Â 10 9 cells/L predicted the development of late diarrhea in the coming days (sensitivity 82.0%, specificity 70.8%, area under the curve = 0.791 [0.710-0.872]).Diarrhea in COVID-19 is heterogeneous, and different types of diarrhea require different management.Abbreviations: COVID-19 = novel coronavirus disease, CRP = C-reactive protein, WBC = white blood cells.

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Pharmacological treatment of biliary dyskinesia is to a great extend aimed at reducing smooth muscle spasms and recovering gallbladder motility. Prolonged courses of myotropic antispasmodics are used as the basic therapy. Hymecromone is notable to its predominantly spasmolytic action on the bile ducts and the sphincter of Oddi without any significant effect on the gallbladder contractility, and therefore it is safe in patients with cholecystolythiasis. Hymecromone decreases the severity of cholestasis, prevents the formation of cholesterol crystals and therefore, the development of cholelithiasis. It is effective both as a monotherapy and in combination with ursodeoxycholic acid for treatment of biliary sludge and prevention of the progression of gallstone disease. Its local action on the biliary tract and low systemic bioavailability after oral intake increases the treatment safety. Experimental studies demonstrated the antifibrotic and antihyperglycaemic effect of the drug. Key words: biliary dysfunction, cholelithiasis, sphincter of Oddi dysfunction, biliary sludge, hymecromone, ursodeoxycholic acid