Clostridioides difficile infection in coronavirus disease 2019 (COVID-19): an underestimated problem?

INTRODuCTION The use of antibiotics and possibility of microbiota disruption during the coronavirus disease 2019 (COVID-19) pandemic have raised questions about the incidence of Clostridioides difficile infection (CDI). OBjECTIvEs This study aimed to assess the frequency of and risk factors for CDI in patients with COVID-19. PATIENTs AND METNODs We conducted a retrospective, single-center evaluation study on the frequency of and risk factors for CDI in patients with COVID-19 and in the prepandemic era. The analysis included 441 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and 2961 patients hospitalized before the pandemic. REsuLTs A significant increase in the incidence of CDI was noted during the COVID-19 pandemic compared with the prepandemic period: 10.9% versus 2.6%, P <0.001. Risk factors for CDI in patients with COVID-19 included: age, length of hospital stay, occurrence of diarrhea during hospitalization, use of antibiotics other than azithromycin, and coexistence of nervous system disease or chronic kidney disease-all of these factos had a weak association with CDI development. The multivariable logistic regression model indicated other unassessed variables that had an impact on the CDI incidence rate. CONCLusIONs We observed a higher incidence of CDI in patients with COVID-19. Antibiotic therapy was a relevant risk factor for CDI, although its effect was weak. Other drugs used during the pandemic were not found to have an impact on disease development. Possible causes of CDI may include fecal microbiota disruption by SARS-CoV-2 infection, but further research is needed to validate this hypothesis.

Automated summary

The study found a significant increase in the incidence of CDI in patients with COVID-19, with risk factors including age, length of hospital stay, and antibiotic use. The disruption of fecal microbiota by SARS-CoV-2 infection is believed to be a possible cause of CDI, with the need for further research to confirm this hypothesis.