Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection

Abstract

Background Coronavirus infectious disease 2019 (COVID-19) is primarily a respiratory disease. However, it may manifest with gastrointestinal symptoms that may overlap with Clostridioides difficile infection (CDI). COVID-19 appears to have higher mortality in those with comorbidities. We aimed to assess the outcomes of coinfection in these patients. Methods A retrospective chart review was conducted to identify patients with CDI and COVID-19 from January 1st, 2020 to November 17th, 2020. Both infections were diagnosed via PCR. Clinical features, treatment for COVID-19 and CDI and outcomes including intensive care unit admission, colectomy, 30 day-mortality and long-term complications were analyzed. Results Overall, 21 patients (20 hospitalized) with median age 70.9 years (range 51.8–90.7 years) had CDI and COVID-19 within 4 weeks of each other. Of these, 4 patients (19%) with CDI were diagnosed with COVID-19 at the time of admission, 12 (57%) had CDI diagnosed after COVID-19, and 5 (23.9%) developed COVID-19 within 4 weeks after CDI. Fourteen patients (66.7%) were treated with medications directed against COVID-19 including remdesivir and dexamethasone (n=7), remdesivir with convalescent plasma (n= 1), remdesivir (n= 5) and dexamethasone (n=1). The most common treatment for CDI was oral vancomycin in 20 patients (95.2%), and 1 patient received intravenous metronidazole. No patient required colectomy for CDI but 2 (9.5%) required ICU admission. Four patients (19%) died likely due to COVID-19 with median age 80 years (range 61–90 years). Conclusion The relationship between COVID-19 and CDI is poorly understood, and studies are required to further investigate this association. Whether coinfection results in a worsening of outcomes, including mortality and clinical course, are questions that should be answered in future research studies. Diagnosing both infections for appropriate management is vital in light of overlapping symptoms.

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

“…In our study, an extremely high percentage of COVID-19 patients received broad-spectrum of antibiotics prior to and during their hospital stay. Similar percentages have been reported by Sehgal et al and Khanna et al in the first half of 2021 [32,33]. Azithromycin was the most frequently prescribed antibiotic for outpatient treatment of COVID-19 as empirical coverage for possible superinfection of the respiratory tract and thus, independently associated with the risk of developing CDI.…”

Post-COVID-19 Syndrome: Nine Months after SARS-CoV-2 Infection in a Cohort of 354 Patients: Data from the First Wave of COVID-19 in Nord Franche-Comté Hospital, France

“…Finally, it is necessary to remember that the upper respiratory tract is the gateway for many different pathogenic viruses such as SARS-CoV-2, but it is also home to commensal and potentially pathogenic bacterial communities. In this context, viral, viral/bacterial co-infections, or superinfections may explain the persistence of symptoms in some patients [ 28 , 29 ].…”

Inadequate use of antibiotics in the covid-19 era: effectiveness of antibiotic therapy

“…In the event its continued use is warranted, switch to oral therapy early and give short cycles of five days [ 26 ]. It is important to educate healthcare providers in antimicrobial stewardship to prevent the consequences of excessive antimicrobial use such as toxicities, selection for opportunistic pathogens such as Clostridioides difficile (coinfection with SARS-CoV-2 results in a worsening of outcomes) and antimicrobial resistance [ 74 , 75 ].…”