Epidemiological and clinical characteristics of Clostridium difficile infections before and during the COVID-19 pandemic

Epidemiological and clinical characteristics of Clostridium difficile infections

  • Darija Knežević Medicinski fakultet Univerzitet u Banjoj Luci
  • Duška Jović University of Banja Luka, Faculty of Medicine
  • Miroslav Petković University of Banja Luka, Faculty of Medicine
Keywords: Clostridium difficile infections, COVID-19 pandemic, Risk factors, Disease outbreak

Abstract


Background/Aim: Diarrhoea that occurs as a result of the presence of Clostridium

difficile (reclassified as Clostridoides difficile) is usually manifested as a hospital

infection, usually after antibiotic treatment. The study aim was to assess

the incidence, characteristics and outcomes of hospitalised patients with healthcare

– associated Clostridioides difficile infection ( HA - CDI) before and during

the COVID-19 pandemic.

Methods: This retrospective cohort study included patients older than 18, who

met the HA - CDI case definition. The CDI diagnosis was made by demonstrating

toxins A and B in stool samples using an immunochromatographic assay test

and polymerase chain reaction (PCR).

Results: The incidence of HA - CDI has significantly decreased from the pre-

COVID-19 period to the COVID-19 period (11.04 per 10,000 vs 6.49 per 10,000,

p < 0.001). Before establishing the HA - CDI diagnosis, 41.4 % of patients used

one antibiotic, 25.9 % used two and 11.2 % were treated with three or more

antibiotics. Almost one half of the applied antibiotics were from the group that

represents high risk for the development of HA - CDI. Multivariable logistic regression

analysis showed that older age (OR = 3.4; 95 % CI = 0.9-12.4; p = 0.038)

and complicated disease course (OR = 11.8; 95 % CI = 2.6-53.6; p ≤ 0.001) were

associated with a higher risk of death.

Conclusion: The incidence of HA - CDI has decreased during the observed period

of the COVID-19 pandemic, however, no clear connection between the impact

of the pandemic and incidence reduction was found. Due to unfavourable

outcome of the treatment of HA - CDI patients during COVID-19 pandemic, the

rational use of antibiotics is necessary.

References

1.      Sheth PM, Douchant K, Uyanwune Y, Larocque M, Anantharajah A, Borgundvaag E, et al. Correction: Evidence of transmission of Clostridium difficile in asymptomatic patients following admission screening in a tertiary care hospital. PLoS One 2019;14(7):e0219579. doi: 10.1371/journal.pone.0219579.

2.      Lawson PA, Citron DM, Tyrrell KL, Finegold SM. Reclassification of Clostridium difficile as Clostridioides difficile (Hall and O’Toole 1935) Prévot 1938. Anaerobe 2016;40:95-9.

3.      Guery B, Galperine T, Barbut F. Clostridioides difficile: Diagnosis and treatments. BMJ 2019;366: l4609. doi: 10.1136/bmj.l4609.

4.      Chandrasekaran R, Borden Lacy D. The role of toxins in Clostridium difficile infection. FEMS Microbiol Rev 2017;41(6):723-50.

5.      Kelly CP, LaMont JT. Clostridium difficile--more difficult than ever. N Engl J Med 2008;359(18):1932-40.

6.      van Nispen tot Pannerden CM, Verbon A, Kuipers EJ. Recurrent Clostridium difficile infection: what are the treatment options? Drugs 2011;71(7):853-68.

7.      Ma J, Dubberke E. Current management of Clostridioides (Clostridium) difficile infection in adults: a summary of recommendations from the 2017 IDSA/SHEA clinical practice guideline. Pol Arch Intern Med 2019;129(3):189-98.

8.      Maharshak N, Barzilay I, Zinger H, Hod K, Dotan I. Clostridium difficile infection in hospitalized patients with inflammatory bowel disease: Prevalence, risk factors  and prognosis. Medicine (Baltimore) 2018;97(5):e9772. doi: 10.1097/MD.0000000000009772.

9.      Núñez-Núñez M, Navarro MD, Palomo V, Rajendran NB, Del Toro MD, Voss A, et al. The methodology of surveillance for antimicrobial resistance and healthcare-associated infections in Europe (SUSPIRE): a systematic review of publicly available information. Clinical Microbiology and Infection 2018;24(2):105-9.

10.   Spigaglia P. Clostridioides difficile infection in the COVID-19 era: Old and new problems. Polish Arch Intern Med 2021;131(2):118-20.

11.   Azimirad M, Noori M, Raeisi H, Yadegar A, Shahrokh S, Asadzadeh Aghdaei H, et al. How does COVID-19 pandemic impact on incidence of Clostridioides difficile infection and exacerbation of its gastrointestinal symptoms? Front Med  2021;8:775063. doi: 10.3389/fmed.2021.775063.

12.   Lavan AH, McCartan DP, Downes MM, Hill ADK, Fitzpatrick F. Monitoring Clostridium difficile infection in an acute hospital: prevalence or incidence studies? Irish J Med Sci 2012;181:315-20.

13.   Bentivegna E, Alessio G, Spuntarelli V, Luciani M, Santino I, Simmaco M, et al. Impact of COVID-19 prevention measures on risk of healthcare-associated Clostridium difficile infection. Am J Infect Control 2021;49:640. doi: 10.1016/j.ajic.2020.09.010.

14.   Merchante N, Chico P, Márquez-Saavedra E, Riera G, Herrero R, González-de-la-Aleja P, et al. Impact of COVID19 pandemic on the incidence of health-care associated Clostridioides difficile infection. Anaerobe 2022;75:102579. doi: 10.1016/j.anaerobe.2022.102579.

15.   Velev V, Pavlova M, Alexandrova E, Popov М, Lutakov I, Cherveniakova T, et al. Study on patients with Clostridioides difficile infection during the COVID-19 pandemic in Bulgaria. Biotechnol Biotechnol Equip 2023;37(1):188-93.

16.   Markovic-Denic L, Nikolic V, Toskovic B, Brankovic M, Crnokrak B, Popadic V, et al. Incidence and risk factors for Clostridioides difficile Infections in non-COVID and COVID-19 patients: experience from a tertiary care hospital. Microorganisms 2023;11(2):435. doi: 10.3390/microorganisms11020435.

17.   Kovačević N, Petrić V, Pete M, Popović M, Plećaš-Đurić A, Pejaković S, et al. Clostridioides Difficile infection before and during Coronavirus Disease 2019 pandemic-similarities and differences. Microorganisms 2022;10(11):2284. doi: 10.3390/microorganisms10112284.

18.   Manea E, Jipa R, Milea A, Roman A, Neagu G, Hristea A. Healthcare-associated Clostridioides difficile infection during the COVID-19 pandemic in a tertiary care hospital in Romania. Rom J Intern Med 2021;59(4):409-15.

19.   Shin JH, High KP, Warren CA. Older is not wiser, immunologically speaking: effect of aging on host response to Clostridium difficile infections. J Gerontol A Biol Sci Med Sci 2016;71:916-22.

20.   Eurosurveillance editorial team. ECDC’s latest publications. Euro Surveill 2018; 23(26):1806282. doi: 10.2807/1560-7917.ES.2018.23.26.1806282.

21.   Mortgat L, Duysburgh E. Epidemiology of Clostridioides difficile infections in Belgian hospitals: Report 2020 (Catry B., Ed). Brussels, Belgium: Sciensano [Internet]. 2021 [Cited:15-Aug-2022]. Available from: https://www.sciensano.be/sites/default/files/report_2020_cdif_v6.pdf. style="mso-spacerun: yes;"> 

22.   Song J, Cohen B, Zachariah P, Liu J, Larson EL. Temporal change of risk factors in hospital-acquired Clostridioides difficile infection using time-trend analysis. Infect Control Hosp Epidemiol 2020;41:1048-57.

23.   van Dorp SM, Kinross P, Gastmeier P, Behnke M, Kola A, Delmée M, et al. Standardised surveillance of Clostridium difficile infection in European acute care hospitals: a pilot study, 2013. Euro Surveill 2016 Jul 21;21(29). doi: 10.2807/1560-7917.ES.2016.21.29.30293.

24.   Finn E  andersson FL, Madin-Warburton M. Burden of Clostridioides difficile infection (CDI) - a systematic review of the epidemiology of primary and recurrent CDI. BMC Infect Dis 2021;21(1):456. doi: 10.1186/s12879-021-06147-y.

25.   Negrut N, Bungau S, Behl T, Khan SA, Vesa CM, Bustea C, et al. Risk factors associated with recurrent Clostridioides difficile infection. Healthcare 2020;8(3):352. doi:10.3390/healthcare8030352.

26.   Na’amnih W, Adler A, Miller-Roll T, Cohen D, Carmeli Y. Risk factors for recurrent Clostridium difficile infection in a tertiary hospital in Israel. Eur J Clin Microbiol Infect Dis 2018;37(7):1281-8.

27.   Park YH, Seong JM, Cho S, Han HW, Kim JY, An SH, et al. Effects of proton pump inhibitor use on risk of Clostridium difficile infection: a hospital cohort study. J Gastroenterol 2019;54(12):1052-60.

28.   Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus Disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020;180(7):1031. doi: 10.1001/jamainternmed.2020.0994.

29.   Carlson TJ, Gonzales-Luna AJ, Wilcox MF, Theriault SG, Alnezary FS, Patel P,  et al. Corticosteroids do not increase the likelihood of primary Clostridioides difficile infection in the setting of broad-spectrum antibiotic use. Open Forum Infect Dis 2021;8(10):ofab419. doi: 10.1093/ofid/ofab419.

30.   Maslennikov R, Ivashkin V, Ufimtseva A, Poluektova E, Ulyanin A. Clostridioides difficile co-infection in patients with COVID-19. Future Microbiol 2022;17:653-63.

31.   Filippidis P, Kampouri E, Woelfle M, Badinski T, Croxatto A, Galperine T, et al. Treatment and outcomes of Clostridioides difficile infection in Switzerland: a two-center retrospective cohort study. J Clin Med 2022;11(13):3805. doi: 10.3390/jcm11133805.

32.   Marinescu AR, Laza R, Filaret Musta V, Cut TG, Dumache R, Tudor A, et al. Clostridium Difficile and COVID-19: general data, ribotype, clinical form, treatment-our experience from the largest infectious diseases hospital in Western Romania. Medicina (Kaunas) 2021 Oct 13;57(10):1099. doi: 10.3390/medicina57101099.

33.   Vázquez-Cuesta S, Olmedo M, Reigadas E, Alcalá L, Marín M, Muñoz P, et al. Clostridioides difficile infection epidemiology and clinical characteristics in COVID-19 pandemic. Front Med 2022;9:953724. doi: 10.3389/fmed.2022.953724.

Published
2023/03/30
Section
Original article