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

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 ction. e factors that influenced CDI development er SARS-CoV-2 infe 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 (Cl): 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%Cl: 1.263-4.986, P = 0.009) and alcohol consumption (OR: 2.550, 95%Cl: 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.

Automated summary

This study found that factors such as age, urban residence, history of antibiotic use, hospitalizations, and alcohol consumption were risk factors for the development of CDI in COVID-19 patients.