C Diff Rates Decreasing Due to Enhanced COVID-19 Measures

Karl Hazel, MD

As the COVID-19 pandemic raged on, hospitals began to put in more and more mitigation measures in an effort to drop the spread of the virus.

In part, these measures may also reduce the spread of other infectious diseases, such as clostridium difficile infection (CDI).

A team, led by Karl Hazel, Beaumont Hospital, determined with improved hand-hygiene, increased use of personal protective equipment (PPE), social distancing, and reduced hospital occupancy during the first wave of the COVID-19 pandemic impacted the rates of hospital acquired CDI rates.

The data was presented during the Digestive Disease Week (DDW) 2021 Virtual Conference.

CDI is currently the leading cause of hospital-acquired infectious diarrhea worldwide, with high bed occupancy rates in a cute hospitals correlating with an increase in healthcare-associated CDI (HA-CDI).

However, the changes to the way the healthcare system operates because of the COVID-19 pandemic, such as the cessation of elective procedures and reduced presentations and a reduction of presentations for non-COVID-19 related illnesses could have an impact of hospital-acquired CDI rates.

The Comparison

The researchers used a study period as March through May 2020 and identified newly-acquired hospital-acquired CDI cases during the same period in 2018 and 2019. C diff cases were identified using the hospital C. difficile database and defined as per national case definitions.

The investigators used electronic records to assess patient demographics and biochemical markers and collected hospital antimicrobial consumption and hand-hygiene audit data for the study period in 2018, 2019, and 2020.

Results

Overall, there were 50 patients with hospital acquired CDI included in the study during the first outbreak of COVID-19. The investigators used Chi-squared analysis with Yates correction to show an overall decrease in newly-acquired HA0CDI during the first wave of the pandemic period when compared to the same time period in 2018 and 2019 (P = 0.029).

“During the first wave of the COVID-19 pandemic, static antimicrobial use, reduced hospital occupancy, improved hand hygiene and the use of PPE resulted in a decline in HA-CDI; demonstrating the importance of hospital activity and infection prevention and control measures on HA-CDI during an inpatient stay,” the authors wrote.

Hospitalization Estimates

Recently, researchers found national estimates of CDI hospitalizations by demographics and patient comorbidities are considered insufficient in the US.

A team, led by Dhanshree Solanki, Edward J Bloustein School of Planning & Public Policy, identified hospitalization rates for C. diff by age group, sex, and region, as well as for patient comorbidity in the US.

In the study, the researchers analyzed the 2017 National Inpatient Sample (NIS) and identified 329,460 CDI-related hospitalizations, accounting for nearly 1% of all hospitalizations.

The average CDI patient was admitted to the hospital at 64.7 years old, which is approximately 20 years older than the average age at admission of all other hospitalizations.

In addition, the highest rate of CDI hospitalizations—716 per 100,000 hospitalizations—was in patients at least 85 years old.

The inverse of that relationship was also true as those 18 years and younger had the lowest rate of hospitalizations at 12 per 100,000 hospitalizations.

The study, “Rates of Hospital-Acquired Clostridioides Infection During the COVID-19 Pandemic in a Tertiary Healthcare Setting,” was published online by DDW.