COVID-19 Patients at Risk of More Severe C Difficile Outcomes

Patients hospitalized with COVID-19 should be concerned with other hospital-acquired infections, including clostridium difficile infections (CDI). However, new research points to an increased risk of severe outcomes, but not necessarily an increased risk of contracting a C difficile infection.

A team, led by Evdokia Gavrielatou, MD, National Kapodistrian University of Athens, evaluated the prevalence of C difficile infections in patients with COVID-19 pneumonia.

COVID-19 infections can be complicated by a co-occurring C difficile infection because of COVID-19’s gastrointestinal microbiome alterations.

Gathering Data

In the retrospective study, the investigators examined patients with positive PCR tests for COVID-19 who were admitted to the intensive care units between September 2020 to April 2021.

Each patient in the cohort was on mechanical ventilation at some point during their ICU admission. The investigators defined hospital-onset (HO-CDI) as a positive C difficile test over 3 days after admission.

The team identified 240 patients with positive PCR tests for COVID-19 admitted to the ICU during the study period. Of this group 4.5% (n = 11) were CDI positive. In addition, 9 of the 11 CDI positive cases were male.

The range of hospital stays for patients with COVID-19 was 1-59 days, with a mean of 12 days an d the HO-CDI median day of identification was 12 days.

All patients received at least 2 antibiotics and dexamethasone at admission.

Results

Overall, patients with COVID-19 did not have a higher overall CDI positive rate when compared to historical controls, but mortality did increase to 63% (n = 7) in patients with concurrent COVID-19 and C difficile infections.

“Whether COVID-19 itself increases an individual’s risk for CDI remains unclear,” the authors wrote. “Multiple contributing factors drive CDI incidence, severity, and recurrence. Although protective measures such as gowns and gloves during COVID-19 increased, CDI cases in the hospital setting should continue to emphasize the importance of antimicrobial stewardship.”

Reducing CDI

Multiple studies have found a decrease in CDI rates during the COVID-19 pandemic in comparison to previous years.

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 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 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.

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).

The study, “Hospital-Onset Clostridioides difficile Infection Rates During COVID-19 Pandemic in the ICU Patients,” was published online in Open Forum Infectious Disease.