Impact of the COVID-19 pandemic on the incidence of healthcare facility-onset Clostridioides difficile infection in hospitalized patients with sepsis: Interrupted time series analysis using Japanese Diagnosis Procedure Combination data

Koji Endo; Kayoko Mizuno; Masato Takeuchi; Koji Kawakami

doi:10.1016/j.anaerobe.2023.102693

Impact of the COVID-19 pandemic on the incidence of healthcare facility-onset Clostridioides difficile infection in hospitalized patients with sepsis: Interrupted time series analysis using Japanese Diagnosis Procedure Combination data

Anaerobe. 2023 Feb:79:102693. doi: 10.1016/j.anaerobe.2023.102693. Epub 2023 Jan 7.

Authors

Koji Endo¹, Kayoko Mizuno¹, Masato Takeuchi¹, Koji Kawakami²

Affiliations

¹ Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoecho, Sakyo-ku, Kyoto-city, Japan.
² Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoecho, Sakyo-ku, Kyoto-city, Japan. Electronic address: kawakami.koji.4e@kyoto-u.ac.jp.

Abstract

Objectives: Healthcare facility-onset Clostridioides difficile infection (HO-CDI) is a major nosocomial infection associated with high mortality and healthcare costs. We aimed to determine if HO-CDI incidence decreased due to the COVID-19 pandemic. We hypothesized that the pandemic decreased HO-CDI as healthcare workers became more diligent in handwashing and sanitization.

Methods: In this retrospective cohort study, adult patients with sepsis hospitalized in general wards from January 2018 to February 2021 were identified using a nationwide Japanese administrative database. Patients were divided into two groups according to the hospitalization date (before and after the first declaration of a state of emergency). The primary outcome was a change in the level of the HO-CDI monthly incidence ratio (per 10000 patient-days).

Results: Of the 49,156 eligible hospitalizations for sepsis, 41,870 were before and 7,283 were after the first state of emergency declaration. Interrupted time-series (ITS) analysis showed no significant difference in the HO-CDI incidence ratio after Japan's first state of emergency declaration (level change -1.0, 95% confidence interval (CI) -8.6 to 6.6, p = 0.8, slope change 0.06, 95% CI -0.17 to 0.3, p = 0.6). The overall HO-CDI incidence ratio was 3.86/10000 patient-days (interquartile range 2.97-4.53); higher incidence existed in subgroups with older adults or a lower Barthel index at admission.

Conclusions: No significant change in HO-CDI incidence was observed in patients with sepsis hospitalized in general wards before and after Japan's first state of emergency declaration. Our study revealed that HO-CDI in general wards in Japan had been consistently decreasing since before the COVID-19 pandemic.

Keywords: COVID-19; Healthcare facility-onset Clostridioides difficile infection; Interrupted time series analysis; Sepsis.

MeSH terms

COVID-19 Testing
COVID-19* / epidemiology
Clostridioides difficile
Clostridium Infections* / diagnosis
Clostridium Infections* / epidemiology
Cross Infection* / epidemiology
Delivery of Health Care
East Asian People
Humans
Incidence
Interrupted Time Series Analysis
Pandemics
Retrospective Studies
Sepsis* / epidemiology