Rates of Clostridioides difficile at an Urban Hospital During Initial COVID Pandemic Wave

Abstract

Background During the first three months of the COVID 19 pandemic, our facility cared for an influx of patients. At the peak, the daily census exceeded 200 patients with COVID 19. Surveillance for healthcare acquired infections (HAIs) continued throughout this time. Despite the acuity of the patients and the frequent use of antibiotics, the rates of Clostridioides difficile lab ID (CDI) events remained relatively stable. We sought to determine the validity of this rate. Methods To determine if cases of CDI were missed, we compared the 3-month rate per 10,000 patient days in 2020 to the same time-period in 2019 (March, April, and May). The number of tests ordered during the two periods was also compared. Additionally, the Doctor of Pharmacy from our antibiotic stewardship team reviewed all orders for oral Vancomycin to determine if empiric CDI treatment was initiated without confirmatory testing. Results The CDI rate for the 3 months in 2019 was zero compared to 0.48 per 10,000 patient days during the peak of the pandemic. The number of tests increased in the 2020 period to 17.5 per 10,000 patient days versus 15.8 in the 2019 period. Three patients received oral Vancomycin, each of whom had valid indications. Conclusions Based on this data, CDI cases were not underreported. We speculate that the lack of an increase in CDI rates may be attributed to: Increased hand hygiene by staff – compliance increased to 91 % in 2020 compared to 83 % in 2019,enhanced attention to cleaning and high level disinfection, and Improved adherence to use of personal protective equipment.

The incidence of nosocomial bloodstream infection and urinary tract infection in Australian hospitals before and during the COVID-19 pandemic: an interrupted time series study

“…Researchers have suggested that this may be due to: resources shortages; influx of patients; changing recommendations; and general stress [ 5 – 7 ]. However, reductions in Clostridioides difficile have also been reported, [ 1 , 8 , 9 ] and generally a lower rate of multidrug resistant organisms - although this was in an area which was at the time not significantly affected by COVID-19 infections [ 10 ] These have been attributed to the increased awareness and practice of standard precautions [ 1 , 10 , 11 ].…”

The incidence of positive bloodstream and urine cultures in five Australian hospitals during the COVID-19 pandemic

“…10 These have been attributed to the increased awareness and practice of standard precautions. 1,10,11 The infection prevention challenges presented by COVID-19 are signi cant. To prepare for the admission and treatment of COVID-19 positive patients, a number of new and modi ed infection prevention initiatives have been implemented across healthcare sites.…”