The Interplay of SARS-CoV-2 and
            <i>Clostridioides Difficile</i>
            Infection

Khanna, Sahil; Kraft, Colleen S.

doi:10.2217/fmb-2020-0275

Cited by 26 publications

(19 citation statements)

References 22 publications

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“…This study emphasizes the unintended consequences of judicious administration of antibiotics throughout the disease course of COVID-19 and bacterial infection such as CDI ( 92 ). Additionally, COVID-19 is an illness with frequent GI symptoms such as nausea, vomiting and diarrhea that induces changes in the gut microbiota composition of infected patients, which can complicate the diagnosis of CDI owing to lack of clinical suspicion ( 119 ). Not only these patients are more susceptible to CDI, but also antibiotics may induce emergence of new virulent strains of C. difficile , which in turn will produce severe consequences in such patients ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…CDI patients possibly may have facilitated the persistence of SARS-CoV-2 in feces almost a month, even after the nasopharyngeal test turned negative. This coinfection might exacerbate the GI signs and symptoms and raise possibility of fecal-oral transmission of SARS-CoV-2 and C. difficile ( 119 , 140 ). Since SARS-CoV-2 virus can be potentially transmitted through fecal matters even in asymptomatic patients, CDI may complicate COVID-19 and lead to higher rate of mortality ( 119 ).…”

Section: Discussionmentioning

confidence: 99%

“…This coinfection might exacerbate the GI signs and symptoms and raise possibility of fecal-oral transmission of SARS-CoV-2 and C. difficile ( 119 , 140 ). Since SARS-CoV-2 virus can be potentially transmitted through fecal matters even in asymptomatic patients, CDI may complicate COVID-19 and lead to higher rate of mortality ( 119 ). Thus, it is needed to clarify the interactions between COVID-19 and CDI.…”

Section: Discussionmentioning

confidence: 99%

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How Does COVID-19 Pandemic Impact on Incidence of Clostridioides difficile Infection and Exacerbation of Its Gastrointestinal Symptoms?

et al. 2021

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Coronavirus disease 2019 (COVID-19) has rapidly spread all over the world with a very high rate of mortality. Different symptoms developed by COVID-19 infection and its impacts on various organs of the human body have highlighted the importance of both coinfections and superinfections with other pathogens. The gastrointestinal (GI) tract is vulnerable to infection with COVID-19 and can be exploited as an alternative transmission route and target for virus entry and pathogenesis. The GI manifestations of COVID-19 disease are associated with severe disease outcomes and death in all age groups, in particular, elderly patients. Empiric antibiotic treatments for microbial infections in hospitalized patients with COVID-19 in addition to experimental antiviral and immunomodulatory drugs may increase the risk of antibiotic-associated diarrhea (AAD) and Clostridioides difficile infection (CDI). Alterations of gut microbiota are associated with depletion of beneficial commensals and enrichment of opportunistic pathogens such as C. difficile. Hence, the main purpose of this review is to explain the likely risk factors contributing to higher incidence of CDI in patients with COVID-19. In addition to lung involvement, common symptoms observed in COVID-19 and CDI such as diarrhea, highlight the significance of bacterial infections in COVID-19 patients. In particular, hospitalized elderly patients who are receiving antibiotics might be more prone to CDI. Indeed, widespread use of broad-spectrum antibiotics such as clindamycin, cephalosporins, penicillin, and fluoroquinolones can affect the composition and function of the gut microbiota of patients with COVID-19, leading to reduced colonization resistance capacity against opportunistic pathogens such as C. difficile, and subsequently develop CDI. Moreover, patients with CDI possibly may have facilitated the persistence of SARS-CoV-2 viral particles in their feces for approximately one month, even though the nasopharyngeal test turned negative. This coinfection may increase the potential transmissibility of both SARS-CoV-2 and C. difficile by fecal materials. Also, CDI can complicate the outcome of COVID-19 patients, especially in the presence of comorbidities or for those patients with prior exposure to the healthcare setting. Finally, physicians should remain vigilant for possible SARS-CoV-2 and CDI coinfection during the ongoing COVID-19 pandemic and the excessive use of antimicrobials and biocides.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

How Does COVID-19 Pandemic Impact on Incidence of Clostridioides difficile Infection and Exacerbation of Its Gastrointestinal Symptoms?

et al. 2021

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“…With the emergence of COVID-19, the majority of the hospitals in developed countries such as the United States have seen a change in system operations. Some of these changes include strict infection control measures along with increased use of personal protective equipment (PPE), environmental disinfection, cessation of elective procedures, and reduction in non-COVID-19-related hospital admissions [5]. All these measures indirectly serve to reduce the incidence of nosocomial CDI.…”

Section: Introductionmentioning

confidence: 99%

Examining the Rate of Clostridioides (Formerly Clostridium) Difficile Infection Pre- and Post-COVID-19 Pandemic: An Institutional Review

Yadlapati¹,

Jarrett²,

Lo³

et al. 2021

Cureus

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Background/ RationaleClostridioides difficile infection (CDI) is transmitted via the fecal-oral route and is implicated in antibioticassociated colitis. Similar to CDI, patients with coronavirus disease 2019 (COVID-19) require early identification and isolation, appropriate personal protective equipment, and environmental disinfection to prevent further transmission. In light of this similarity between isolation and protective requirements to prevent transmission of these diseases, we aim to investigate whether there was a decrease in the incidence of CDI during the peak periods of the COVID-19 pandemic compared to historical rates. MethodsThis is a single-center retrospective analysis of the rates of CDI in our institution. COVID-19 time periods were identified from March 2020 to January 2021 and peak periods (with >50 active patients per day) were defined. The non-COVID-19 periods were July 2017 to February 2020. Rates of CDI were also directly compared across the yearly time period. CDI rates were presented in a per 1000 patient days format. Rates were analyzed per year and during the COVID-19 peaks at our institution. Mann-Whitney U test was used to compare rates between two time periods, while differences across multiple time intervals were analyzed using the Kruskal-Wallis test. ResultsThe median (interquartile range [IQR]) of CDI rates of infection per 1000 patient days for the non-COVID time period from July 2017 to February 2020 was 0.34 (0.23-0.45) while COVID time periods had higher 0.44 (0.25-0.51) rates of CDI although this was not statistically significant (p=0.224). However, there was a statistically significant difference (p=0.036) with COVID peak periods having higher rates of CDI 0.49(0.39-0.74) vs 0.34(0.23-0.44). Overall, there was no statistically significant difference in the rates of CDI across years or time periods (p=0.396). Discussion/ConclusionThere was no difference in the rates of hospital-acquired CDI between COVID-19 and non-COVID-19 time periods at our institution.

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“…Other evidence of bacterial co‐infections in severe COVID‐19 are the presence of elevated ferritin, [ 70 , 71 ] C‐reactive protein, [ 71 , 72 , 73 , 74 ] procalcitonin levels, [ 71 , 74 ] as well as eosinopenia and lymphopenia [ 74 , 75 ] and cytokine overproduction syndrome (reviewed in [ 69 ] ), all of which are independently diagnostic for bacterial infections and differentiate severe cases from mild and asymptomatic ones. The preceding considerations along with direct evidence of bacterial infections in non‐COVID thrombocytopenias [ 76 , 77 ] and some COVID‐19 coagulopathy cases [ 78 , 79 , 80 , 81 ] have led Di Micco et al. [ 82 ] to conclude that, “Patients with COVID‐19, because of its tendency to induce leucopenia and overlapping of bacterial infection, may experience sudden disseminated intravascular coagulation (DIC).”…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 coagulopathies: Human blood proteins mimic SARS‐CoV‐2 virus, vaccine proteins and bacterial co‐infections inducing autoimmunity

Root‐Bernstein

2021

BioEssays

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Severe COVID‐19 is often accompanied by coagulopathies such as thrombocytopenia and abnormal clotting. Rarely, such complications follow SARS‐CoV‐2 vaccination. The cause of these coagulopathies is unknown. It is hypothesized that coagulopathies accompanying SARS‐CoV‐2 infections and vaccinations result from bacterial co‐infections that synergize with virus‐induced autoimmunity due to antigenic mimicry of blood proteins by both bacterial and viral antigens. Coagulopathies occur mainly in severe COVID‐19 characterized by bacterial co‐infections with Streptococci , Staphylococci , Klebsiella , Escherichia coli , and Acinetobacter baumannii . These bacteria express unusually large numbers of antigens mimicking human blood antigens, as do both SARS‐CoV‐2 and adenoviruses. Bacteria mimic cardiolipin, prothrombin, albumin, and platelet factor 4 (PF4). SARS‐CoV‐2 mimics complement factors, Rh antigens, platelet phosphodiesterases, Factors IX and X, von Willebrand Factor (VWF), and VWF protease ADAMTS13. Adenoviruses mimic prothrombin and platelet factor 4. Bacterial prophylaxis, avoidance of vaccinating bacterially infected individuals, and antigen deletion for vaccines may reduce coagulopathy risk. Also see the video abstract here: https://youtu.be/zWDOsghrPg8

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The Interplay of SARS-CoV-2 and Clostridioides Difficile Infection

Cited by 26 publications

References 22 publications

How Does COVID-19 Pandemic Impact on Incidence of Clostridioides difficile Infection and Exacerbation of Its Gastrointestinal Symptoms?

How Does COVID-19 Pandemic Impact on Incidence of Clostridioides difficile Infection and Exacerbation of Its Gastrointestinal Symptoms?

Examining the Rate of Clostridioides (Formerly Clostridium) Difficile Infection Pre- and Post-COVID-19 Pandemic: An Institutional Review

COVID‐19 coagulopathies: Human blood proteins mimic SARS‐CoV‐2 virus, vaccine proteins and bacterial co‐infections inducing autoimmunity

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