Prevalence and Health Outcomes of Clostridioides difficile Infection During the Coronavirus Disease 2019 Pandemic in a National Sample of United States Hospital Systems

Kelly R Reveles; Alexa L Frei; Kelsey A Strey; Eric H Young

doi:10.1093/ofid/ofac441

Prevalence and Health Outcomes of Clostridioides difficile Infection During the Coronavirus Disease 2019 Pandemic in a National Sample of United States Hospital Systems

Open Forum Infect Dis. 2022 Aug 25;9(9):ofac441. doi: 10.1093/ofid/ofac441. eCollection 2022 Sep.

Authors

Kelly R Reveles^{1

2}, Alexa L Frei^{1

2

3}, Kelsey A Strey^{1

2}, Eric H Young^{1

2}

Affiliations

¹ College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.
² Pharmacotherapy Education and Research Center, University of Texas Health San Antonio, San Antonio, Texas, USA.
³ College of Agriculture and Life Sciences, Texas A&M University, College Station, Texas, USA.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented emphasis on infection control procedures; however, it is unknown whether the pandemic altered Clostridioides difficile infection (CDI) prevalence. This study investigated CDI prevalence before and during the COVID-19 pandemic in a national sample of United States (US) hospitals.

Methods: This was a retrospective cohort study using the Premier Healthcare Database. Patients with laboratory-confirmed CDI from April 2019 through March 2020 (pre-COVID-19 period) and April 2020 through March 2021 (COVID-19 period) were included. CDI prevalence (CDI encounters per 10 000 total encounters) and inpatient outcomes (eg, mortality, hospital length of stay) were compared between pre-COVID-19 and COVID-19 periods using bivariable analyses or interrupted time series analysis.

Results: A total of 25 992 CDI encounters were included representing 22 130 unique CDI patients. CDI prevalence decreased from the pre-COVID-19 to COVID-19 period (12.2 per 10 000 vs 8.9 per 10 000, P < .0001), driven by a reduction in inpatient CDI prevalence (57.8 per 10 000 vs 49.4 per 10 000, P < .0001); however, the rate ratio did not significantly change over time (RR, 1.04 [95% confidence interval, .90-1.20]). From the pre-COVID-19 to COVID-19 period, CDI patients experienced higher inpatient mortality (5.5% vs 7.4%, P < .0001) and higher median encounter cost ($10 832 vs $12 862, P < .0001).

Conclusions: CDI prevalence decreased during the COVID-19 pandemic in a national US sample, though at a rate similar to prior to the pandemic. CDI patients had higher inpatient mortality and encounter costs during the pandemic.

Keywords: COVID-19; Clostridioides difficile; epidemiology; mortality.