Clostridium Difficile and COVID-19: General Data, Ribotype, Clinical Form, Treatment-Our Experience from the Largest Infectious Diseases Hospital in Western Romania

Abstract

Background and Objectives: In Coronavirus Disease 2019 (COVID-19), which is caused by the infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the clinical manifestations are primarily related to the pulmonary system. Under 10% of cases also develop gastrointestinal events such as diarrhea, nausea, vomiting and abdominal pain. Materials and Methods: We conducted an observational, retrospective study in the Infectious Diseases Clinic of ‘’Victor Babes’’ Hospital, Timis County, in order to assess the incidence, outcome and risk factors for Clostridium Difficile infection (CDI) in COVID-19 patients. Results: Out of 2065 COVID-19 cases, hospitalized between 1st September 2020 and 30th April 2021, 40 cases of CDI were identified with 32 cases of hospital-onset of CDI and eight cases of community-onset and healthcare-associated CDI. By randomization, polymerase chain reaction ribotyping of Clostridium Difficile was performed in six cases. All the randomized cases tested positive for ribotype 027. The percentage of cases recovered with complications at discharge was higher among COVID-19 patients and CDI (p = 0.001). The in-hospital stay, 36 days versus 28 days, was longer among COVID-19 patients and CDI (p = 0.01). The presence of previous hospitalization (p = 0.004) and administration of antibiotics during the hospital stay, increased the risk of CDI among COVID-19 patients. The mean adjusted CCI at admission was lower among controls (p = 0.01). In two cases, exitus was strictly CDI-related, with one case positive for 027 ribotype. Conclusions: CDI has complicated the outcome of COVID-19 patients, especially for those with comorbidities or previously exposed to the healthcare system. In the face of the COVID-19 pandemic and the widespread, extensive use of antibiotics, clinicians should remain vigilant for possible CDI and SARS-CoV-2 co-infection.

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

“…Our results confirm the conclusions of many studies about an extremely high percentage of antibiotic use before the onset of CDI both during the pandemic and in the prepandemic period. The situation was similar in many other countries [6,17,31,32]. In the pandemic era, macrolides, third-generation cephalosporins, and quinolones were the most commonly prescribed antibiotics for the treatment of COVID-19 in our patients as empiric therapy for potential bacterial superinfection of the respiratory tract.…”

Bacterial and Fungal Superinfections in COVID-19 Patients Hospitalized in an Intensive Care Unit from Timișoara, Romania

“…As the HAI were not limited to pneumonia and bacteremia, the samples in which Clostridioides difficile toxins were detected (14.21%) should also be noted. In a study published by Marinescu et al and conducted in Timisoara, 23 it was found that 75% of COVID-positive patients who developed Clostridioides difficile were treated with antibiotics during the last 2 months. The destruction of the balance of the intestinal microbiota is inherent in the conditions of generalized antibiotic therapy.…”

Severe Thrombocytopenic Purpura Associated with COVID-19 in a Pediatric Patient

“…Since being firstly documented at the end of 2019, in Wuhan (China), the corona-virus disease 2019 (COVID-19), a zoonotic infection caused by the enveloped, positive-sense RNA single-stranded SARS-CoV-2, a novel member of the β-coronavirus genus, has spread rampantly, raising major public health concerns, and applying continuous strain on the global medical infrastructure. 9 , 10 SARS-CoV-2, initially thought to be limited to the respiratory tract, is now known to cause a diverse spectrum of clinical manifestations. 11 , 12 As more reports emerge in literature, it appears that glycoprotein spikes on the surface of SARS-CoV-2 engage angiotensin-converting enzyme-2 (ACE-2) receptors on respiratory epithelium, macrophages, and cardiac myocytes.…”