Did the severe acute respiratory syndrome-coronavirus 2 pandemic cause an endemic Clostridium difficile infection?

Camelia Cojocariu; Irina Girleanu; Anca Trifan; Andrei Olteanu; Cristina Maria Muzica; Laura Huiban; Stefan Chiriac; Ana Maria Singeap; Tudor Cuciureanu; Catalin Sfarti; Carol Stanciu

doi:10.12998/wjcc.v9.i33.10180

Did the severe acute respiratory syndrome-coronavirus 2 pandemic cause an endemic Clostridium difficile infection?

World J Clin Cases. 2021 Nov 26;9(33):10180-10188. doi: 10.12998/wjcc.v9.i33.10180.

Affiliations

¹ Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, "St. Spiridon" University Hospital, Institute of Gastroenterology and Hepatology, Iasi 700115, Romania.
² Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, "St. Spiridon" University Hospital, Institute of Gastroenterology and Hepatology, Iasi 700115, Romania. ancatrifan@yahoo.com.

Abstract

Background: Clostridium difficile infection (CDI) has increased in prevalence during the last years. The coronavirus disease 2019 (COVID-19) pandemic has negatively influenced patient outcomes. The majority of the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)-infected patients received antibiotics during hospitalization.

Aim: To analyze the factors that influenced CDI development after SARS-CoV-2 infection.

Methods: Between March 2020 to December 2020, we performed a prospective observational study including 447 patients diagnosed with CDI who were admitted to our tertiary referral university hospital. The diagnosis of CDI was based on the presence of diarrhea (≥ 3 watery stools within 24 h) associated with Clostridium difficile toxins A or B. We excluded patients with other etiology of acute diarrhea.

Results: Among the total 447 (12.5%) patients with CDI, most were male (54.3%) and mean age was 59.7 ± 10.8 years. Seventy-six (17.0%) had history of COVID-19, most being elderly (COVID-19: 62.6 ± 14.6 years vs non-COVID-19: 56.8 ± 17.6 years, P = 0.007), with history of alcohol consumption (43.4% vs 29.4%, P = 0.017), previous hospitalizations (81.6% vs 54.9%, P < 0.001) and antibiotic treatments (60.5% vs 35.5%, P < 0.001), requiring higher doses of vancomycin and prone to recurrent disease (25.0% vs 13.1%, P = 0.011). Age over 60 years [odds ratio (OR): 2.591, 95% confidence interval (CI): 1.452-4.624, P = 0.001], urban residence (OR: 2.330, 95%CI: 1.286-4.221, P = 0.005), previous antibiotic treatments (OR: 1.909, 95%CI: 1.083-3.365, P = 0.025), previous hospitalizations (OR: 2.509, 95%CI: 1.263-4.986, P = 0.009) and alcohol consumption (OR: 2.550, 95%CI: 1.459-4.459, P = 0.001) were risk factors of CDI in COVID-19.

Conclusion: CDI risk is unrelated to history of SARS-CoV-2 infection. However, previous COVID-19 may necessitate higher doses of vancomycin for CDI.

Keywords: Antibiotic use; COVID-19 infection; Clostridium difficile infection; Pandemic; Recurrence; Risk factors.