Early viral versus late antibiotic-associated diarrhea in novel coronavirus infection

Abstract

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.

Antibiotics Use in COVID-19 Patients: A Systematic Literature Review

“…Two-hundred-forty-five studies were excluded for not reporting data on antibiotic use in COVID-19 patients. From the remaining 118 studies, 36 studies were included in this systematic review ( Figure 1 ) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

“…Of the 36 studies included in the systematic review, 32 studies were on the use of antibiotics in COVID-19 inpatients [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]; 4 reported on antibiotic use in COVID-19 outpatients [ 37 , 38 , 39 , 40 ].…”

Clostridioides Difficile Co-Infection in Patients with COVID-19

“…The authors used data from the electronic medical records of patients admitted to the clinic. The authors excluded patients with diarrhea due to other causes as well as those who had viral diarrhea, defined as self-limiting, short-term, mild diarrhea that developed before taking antibiotics or in the first days of taking them (no later than 10 days from the onset of the disease) [ 3 , 12 ]; took laxatives; died during the first day of hospitalization of causes not associated with COVID-19 and diarrhea; and had diarrhea but had not been tested for C. difficile toxins in feces. The following diseases were considered chronic: hypertension, coronary artery disease, asthma, chronic obstructive pulmonary disease, chronic hepatitis, cirrhosis, leukemia, chronic anemia, rheumatoid arthritis and other rheumatic diseases, cancer, diabetes, chronic glomerulopathies and other diseases that lasted at least 6 months.…”

“…The authors considered diarrhea to be the presence of loose or watery stools or an increase in the frequency of bowel movements (more than three per day). COVID-19 patients whose diarrhea was considered AAD [ 12 ] and had lasted at least 5 days or occurred at least five times per day were tested for C. difficile toxins with a fecal immunochromatographic rapid test (VedaLab, Cerisé, France). The presence of C. difficile infection was confirmed by the detection of at least one of its toxins [ 13 ].…”

Determination of Probiotics Prescription Indications in Patients with Irritable Bowel Syndrome (Materials of the Expert Council and Literature Review)

“…Помимо поражения легких, при инфекции COVID-19 достаточно часто наблюдается поражение органов ЖКТ, при этом почти у 10 % больных развивается вирусная диарея[27]. Частое применение массивной антибактериальной www.gastro-j.ru Рос журн гастроэнтерол гепатол колопроктол 2022; 32(2) / Rus J Gastroenterol Hepatol Coloproctol 2022; 32(2) терапии при новой коронавирусной инфекции усугубляет течение вирусной диареи за счет развития ААД и инфекции C. difficile[28]. Учитывая клинический потенциал пробиотиков в купировании инфекционной диареи и профилактике ААД, изучение их влияния на течение COVID-19 представляется крайне важным для клинической практики.…”