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