Examining the Rate of Clostridioides (Formerly Clostridium) Difficile Infection Pre- and Post-COVID-19 Pandemic: An Institutional Review

Sujani Yadlapati; Simone A Jarrett; Kevin B Lo; Jamie Sweet; Thomas A Judge

doi:10.7759/cureus.20397

Examining the Rate of Clostridioides (Formerly Clostridium) Difficile Infection Pre- and Post-COVID-19 Pandemic: An Institutional Review

Cureus. 2021 Dec 13;13(12):e20397. doi: 10.7759/cureus.20397. eCollection 2021 Dec.

Authors

Sujani Yadlapati¹, Simone A Jarrett², Kevin B Lo², Jamie Sweet³, Thomas A Judge⁴

Affiliations

¹ Gastroenterology and Hepatology, Cooper University Hospital, Camden, USA.
² Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, USA.
³ Infectious Disease, Einstein Medical Center Philadelphia, Philadelphia, USA.
⁴ Gastroenterology, Cooper University Hospital, Camden, USA.

Abstract

Background/ Rationale Clostridioides difficile infection (CDI) is transmitted via the fecal-oral route and is implicated in antibiotic-associated colitis. Similar to CDI, patients with coronavirus disease 2019 (COVID-19) require early identification and isolation, appropriate personal protective equipment, and environmental disinfection to prevent further transmission. In light of this similarity between isolation and protective requirements to prevent transmission of these diseases, we aim to investigate whether there was a decrease in the incidence of CDI during the peak periods of the COVID-19 pandemic compared to historical rates. Methods This is a single-center retrospective analysis of the rates of CDI in our institution. COVID-19 time periods were identified from March 2020 to January 2021 and peak periods (with >50 active patients per day) were defined. The non-COVID-19 periods were July 2017 to February 2020. Rates of CDI were also directly compared across the yearly time period. CDI rates were presented in a per 1000 patient days format. Rates were analyzed per year and during the COVID-19 peaks at our institution. Mann-Whitney U test was used to compare rates between two time periods, while differences across multiple time intervals were analyzed using the Kruskal-Wallis test. Results The median (interquartile range [IQR]) of CDI rates of infection per 1000 patient days for the non-COVID time period from July 2017 to February 2020 was 0.34 (0.23-0.45) while COVID time periods had higher 0.44 (0.25-0.51) rates of CDI although this was not statistically significant (p=0.224). However, there was a statistically significant difference (p=0.036) with COVID peak periods having higher rates of CDI 0.49(0.39-0.74) vs 0.34(0.23-0.44). Overall, there was no statistically significant difference in the rates of CDI across years or time periods (p=0.396). Discussion/Conclusion There was no difference in the rates of hospital-acquired CDI between COVID-19 and non-COVID-19 time periods at our institution.

Keywords: c. diff; covid-19 outbreak; hospital-acquired infection; nosocomial infections; personal protective equipment (ppe).