Aalam Sohal, MBBS

While the rates of clostridiodes difficile infections (CDI) are relatively low in patients with COVID-19 who are hospitalized, individuals with the double infections are at an increased risk of a number of negative outcomes, including higher mortality rates.

A team, led by Aalam Sohal, MBBS, Liver Institute Northwest, assessed the prevalence and impact of CDI in a population of hospitalized patients withCOVID-19 infections in the US.

Patients With COVID-19

In the study, the investigators took data from the 2020 National Inpatient Sample database to identify adult patients with COVID-19. These individuals were stratified into 2 separate groups based on the presence of CDI.

The team sought main outcomes of the impact of CDII on in-hospital mortality, intensive care unit (ICU) admissions, shock, acute kidney injuries (AKI), and sepsis rates.

They then performed multivariate regression analysis to assess the effects of CDI on the different outcomes.

The study included 1.5 million patients with COVID-19, 0.65% of which had a CDI.`

Results

The results show there was a higher incidence of mortality in the CDI group compared to patients without COVID-19 (23.25% vs. 13.33%; P <0.001).

For some of the outcomes, patients with COVID-19 and CDI had a higher incidence of sepsis (7.69% vs. 5%, P <0.001), shock (23.59% vs. 8.59%, P <0.001), ICU admission (25.54% vs. 12.28%, P <0.001) and AKI (47.71% vs. 28.52%, P <0.001).

After conducting the multivariable analysis, the investigators found patients with CDII had a statistically significant higher risk of mortality (aOR, 1.47; P <0.001) compared to those without CDI

There was also a statistically significant higher risk of sepsis (aOR, 1.47; P <0.001), shock (aOR, 2.7; P <0.001), AKI (aOR, 1.5; P <0.001), and ICU admission (aOR, 2.16; P <0.001) in the study population.

“Our study revealed the prevalence of CDI in COVID-19 patients was 0.65%. Although the prevalence was low, its presence is associated with worse outcomes and higher resource utilization,” the authors wrote.

Infections During the Pandemic

Mitigation measures and a reduction in patients may have had an impact on some hospital-acquired infections during the COVID-19 pandemic, while other infections may have increased.

Last year, a team, led by Martin E. Evans, MD, National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, assessed how the COVID-19 pandemic impacted healthcare-associated infections in 128 acute care and 132 long-term care Veterans Affairs facilities.

In the study, the investigators examined infection rates for central line-associated bloodstream infections (CLABSIs), ventilator-associated events (VAEs), catheter-associated urinary tract infections (CAUTIs), and methicillin-resistant Staphylococcus aureus (MRSA), and Clostridioides difficile infections.

The data shows admissions to the nationwide VA for COVID-19 infections peaked in January 2021, resulting in significant increases in CLABSIs, VAEs, and MRSA all-site hospital-acquired infections at acute care facilities during the pandemic.

The study, “The Burden of Clostridioides Difficile on COVID-19 Hospitalizations in the United States,” was published online in the Journal of Gastroenterology and Hepatology.