Impact of COVID19 pandemic on the incidence of health-care associated Clostridioides difficile infection

Merchante, Nicolás; Chico, Pablo; Márquez-Saavedra, Esther; Riera, Gerónima; Herrero, Rocío; González-de-la-Aleja, Pilar; Aller, Ana Isabel; Rodrı́guez, Juan Carlos; Rodríguez-Fernández, Miguel; Ramos, José Manuel; Trigo-Rodríguez, Marta; Merino, Esperanza

doi:10.1016/j.anaerobe.2022.102579

Cited by 7 publications

(7 citation statements)

References 24 publications

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“…A study showed no difference in HA-CDI rate despite increased use of broad-spectrum antibiotics during the COVID-19 period. 2,12 Similarly, results shown in the studies done in a single center, offering the same standard of care were associated with advanced patient age, prolonged hospitalizations, and widespread antibiotic usage which are known risk factors for HA-CDI. [11][12][13] Our study found the increased length of hospital stay and prolonged ICU stay during the COVID-19 period can contribute to additional risk of getting hospital-acquired infection.…”

Section: Discussionmentioning

confidence: 78%

“…Many studies have shown the rate of CDI was low during the pandemic and concluded that maintaining the standard preventive measures would ultimately reduce the rate of CDI. 2,[9][10][11] One study adjusted the rate with decreased CDI testing during the COVID period concluding the initial observance of increased rate adjusted for delayed diagnostics. 9 Our center already had implemented the best standard method and despite all these measures, our study showed a static rate of HA-CDI same as some of the few studies that had shown no difference in CDI in 2020 versus 2019 concluding the extra precaution did not affect the incidence of HA CDI.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have shown this infection prevention has limited the spread of many organisms especially those causing healthcare-associated infections, including Clostridium difficile. [1][2][3] Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections with an increase in morbidity, mortality, and prolonged hospitalization. 1 Healthcare-associated CDI (HA-CDI) is defined as any hospitalized patient with symptoms onset ≥ 72 hours after admission with a history of diarrhea (≥ 3 unformed stools in 24 hours with no other recognized cause) along with positive stool testpolymerase chain reaction (PCR) for toxigenic CD and positive PCR for CD toxin gene(s) or colonoscopic/ histopathologic findings of pseudomembranous colitis.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Personal Protective Equipment usage and hand washing due to COVID-19 on the rate of HA-CDI

Sabu Kurian,

Shrestha,

Santos

et al. 2023

WTJOM

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Background: Clostridium difficile infection (CDI) is one of the most common healthcare-associated (HA) infections. Advanced age, use of proton pump inhibitors, concomitant antibiotics, steroids, prolonged hospital stay, and gastrointestinal surgeries are associated with increased incidence of disease. CDI is transmissible via the fecal-oral route by ingestion of spores and is readily transmitted in the hospital between patients and caregivers. Strict contact precautions and handwashing are implemented in health care settings to prevent its transmission. The current pandemic of Coronavirus disease (COVID-19) has led to imposing restrictions on patient admission, visitor visit and implementing extra measures on handwashing along with the use of personal protective equipment (PPE). Therefore, the main objective of this study is to identify if additional preventive measures for COVID-19 have any impact on the rate of HA-CDI. Methods: A retrospective study was conducted on patients diagnosed with HA-CDI during the COVID-19 year (2020) and compared with patients of the pre-COVID-19 year (2019) from March to October. A comparison of baseline characteristics, risk factors and patient hospitalization were compared. Results: During the study period, a total of 148 cases were diagnosed with HA-CDI of which 75 cases were in the pre-COVID-19 and 73 cases in COVID-19 year accounting for a total of 149,092 and 136,982 inpatient bed days respectively. The rate of HA-CDI was 5.03 vs 5.33 per 10,000 hospitalized patients in the pre-COVID-19 year vs COVID-19 year. No significant differences in baseline demographic characteristics, (age, sex, race and BMI); comorbidities (diabetes and hypertension) and risk factors like cancer and steroid use were observed between the two groups. Factors associated with CDI like antibiotic use (p=0.001) and proton pump inhibitor use (p= 0.005) was significantly lower in COVID-19 year. However, there was a significantly high number of patients that had undergone gastrointestinal (GI) surgery (22.6% vs 6.6%, p=0.01) during COVID-19 year. Almost half of the patients in each group stayed in the intensive care unit (ICU) and the mean length of ICU stay was significantly higher in COVID-19 year (20.4± 34.3 days vs 11.6± 16.9 days, p= 0.03). The mortality rate was higher (20.5% vs 12%, p= 0.23) during COVID-19 period. A sub-analysis was done with 2020 data to identify if there lies any contributing factors to the increase CDI rate. 21 cases were positive for COVID-19, of which 28.5% underwent GI surgery; 19% received steroids (Dexamethasone), 76.1% stayed in ICU with median LOS (16± 20.2) and 52.3% died. Conclusions: Based on our observations, a slightly higher rate of symptomatic HA-CDI was observed during COVID-19 year when compared with pre-COVID-19 year. Implementation of measures to prevent the spread of COVID-19 e.g., use of PPE, handwashing, environmental cleaning, visitor restriction etc. were expected to help decrease HA-CDI, which was not observed in our study. We did observe longer ICU stay and higher rate of GI surgery among patients who had HA-CDI in 2020. Higher acuity patients and increased rate of these risk factors amongst patients admitted in year 2020 might have offset the expected benefit of COVID-19 prevention strategies.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Personal Protective Equipment usage and hand washing due to COVID-19 on the rate of HA-CDI

Sabu Kurian,

Shrestha,

Santos

et al. 2023

WTJOM

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“…The studies conducted by Italian and Spanish authors showed similar results, where the incidence of HA -CDI during 2020 was significantly lower compared to the period before the COVID-19 pandemic. 13,14 Contrary to these studies, Velev et al found a significant increase in the incidence of HA -CDI during the COVID-19 pandemic compared to the pre-pandemic period at one university hospital in Bulgaria. 15 In the group of HA -CDI patients during the observed period in 2020, 40.5 % patients had COVID-19 as the primary disease.…”

Section: Discussionmentioning

confidence: 88%

Epidemiological and clinical characteristics of patients with healthcare: Associated Clostridioides difficile infection before and during the COVID-19 pandemic

Knežević¹,

Jović²,

Petković³

2023

Scripta Medica

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Background/Aim: Diarrhoea that occurs as a result of the presence of Clostridium difficile (reclassified as Clostridioides difficile) is usually manifested as a hospital infection, usually after antibiotic treatment. The study aim was to assess the incidence, characteristics and outcomes of hospitalised patients with healthcare - associated Clostridioides difficile infection (HA - CDI) before and during the COVID-19 pandemic. Methods: This retrospective cohort study included patients older than 18, who met the HA - CDI case definition. The CDI diagnosis was made by demonstrating toxins A and B in stool samples using an immunochromatographic assay test and polymerase chain reaction (PCR). Results: The incidence of HA - CDI has significantly decreased from the preCOVID-19 period to the COVID-19 period (11.04 per 10,000 vs 6.49 per 10,000, p < 0.001). Before establishing the HA - CDI diagnosis, 41.4 % of patients used one antibiotic, 25.9 % used two and 11.2 % were treated with three or more antibiotics. Almost one half of the applied antibiotics were from the group that represents high risk for the development of HA - CDI. Multivariable logistic regression analysis showed that older age (OR = 3.4; 95 % CI = 0.9-12.4; p = 0.038) and complicated disease course (OR = 11.8; 95 % CI = 2.6-53.6; p ≤ 0.001) were associated with a higher risk of death. Conclusion: The incidence of HA - CDI has decreased during the observed period of the COVID-19 pandemic, however, no clear connection between the impact of the pandemic and incidence reduction was found. Due to unfavourable outcome of the treatment of HA - CDI patients during COVID-19 pandemic, the rational use of antibiotics is necessary.

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“…That trend was mainly attributed to better adherence to infection prevention protocols [ 4 , 6 ]. Moreover, other analyses on CDI incidence rates and antibiotic use during the pandemic, revealed surprising results: Despite antibiotics’ inherent risk of CDI development and the higher utilization of antibiotics during the pandemic, unchanged and/or lower CDI incidence rates were described [ 1 , 14 , 16 , 17 ]. Additionally, it’s noteworthy that there were also reports of a significantly higher burden on CDI patients during the pandemic despite the lower numbers [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile Infection Rates During the Pandemic in New York Capital Area: A Single-Center Study

Zouridis¹,

Sangha²,

Feustel³

et al. 2023

Cureus

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IntroductionClostridioides difficile (C. difficile) colonizes the large intestine, rendering healthy individuals asymptomatic carriers of the disease. In certain instances, C. difficile infection (CDI) occurs. Antibiotic use remains the leading risk factor for CDI. During the coronavirus disease 2019 (COVID-19) pandemic, multiple risk and protective factors for and against CDI were identified, and as such multiple studies tried to analyze the pandemic's overall effect on CDI incidence rates, with contradictory results. Our study's aim is to further characterize the CDI incidence rates trends, but for a longer period of 22 months in the pandemic. MethodsWe included only adult (>18 years) patients, diagnosed with CDI during their hospitalization for the following period

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Impact of COVID19 pandemic on the incidence of health-care associated Clostridioides difficile infection

Cited by 7 publications

References 24 publications

Impact of Personal Protective Equipment usage and hand washing due to COVID-19 on the rate of HA-CDI

Impact of Personal Protective Equipment usage and hand washing due to COVID-19 on the rate of HA-CDI

Epidemiological and clinical characteristics of patients with healthcare: Associated Clostridioides difficile infection before and during the COVID-19 pandemic

Clostridium difficile Infection Rates During the Pandemic in New York Capital Area: A Single-Center Study

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