Effect of the COVID-19 Pandemic on Rates and Epidemiology of Clostridioides difficile Infection in One VA Hospital

Author:

Wright Lorinda M.1ORCID,Skinner Andrew M.12ORCID,Cheknis Adam1,McBurney Conor1,Ge Ling1,Pacheco Susan M.12,Leehey David12,Gerding Dale N.1,Johnson Stuart12

Affiliation:

1. Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA

2. Chicago Stritch School of Medicine, Loyola University, 2160 S. First Ave., Maywood, IL 60153, USA

Abstract

The COVID-19 pandemic was associated with increases in some healthcare-associated infections. We investigated the impact of the pandemic on the rates and molecular epidemiology of Clostridioides difficile infection (CDI) within one VA hospital. We anticipated that the potential widespread use of antibiotics for pneumonia during the pandemic might increase CDI rates given that antibiotics are a major risk for CDI. Hospital data on patients with CDI and recurrent CDI (rCDI) were reviewed both prior to the COVID-19 pandemic (2015 to 2019) and during the pandemic (2020–2021). Restriction endonuclease analysis (REA) strain typing was performed on CD isolates recovered from stool samples collected from October 2019 to March 2022. CDI case numbers declined by 43.2% in 2020 to 2021 compared to the annual mean over the previous 5 years. The stool test positivity rate was also lower during the COVID-19 pandemic (14.3% vs. 17.2%; p = 0.013). Inpatient hospitalization rates declined, and rates of CDI among inpatients were reduced by 34.2% from 2020 to 2021. The mean monthly cases of rCDI also declined significantly after 2020 [3.38 (95% CI: 2.89–3.87) vs. 1.92 (95% CI: 1.27–2.56); p = <0.01]. Prior to the pandemic, REA group Y was the most prevalent CD strain among the major REA groups (27.3%). During the first wave of the pandemic, from 8 March 2020, to 30 June 2020, there was an increase in the relative incidence of REA group BI (26.7% vs. 9.1%); After adjusting for CDI risk factors, a multivariable logistic regression model revealed that the odds of developing an REA group BI CDI increased during the first pandemic wave (OR 6.41, 95% CI: 1.03–39.91) compared to the pre-pandemic period. In conclusion, the incidence of CDI and rCDI decreased significantly during the COVID-19 pandemic. In contrast, REA BI (Ribotype 027), a virulent, previously epidemic CD strain frequently associated with hospital transmission and outbreaks, reappeared as a prevalent strain during the first wave of the pandemic, but subsequently disappeared, and overall CDI rates declined.

Funder

United States Department of Veterans Affairs

Publisher

MDPI AG

Subject

Pharmacology (medical),Infectious Diseases,Microbiology (medical),General Pharmacology, Toxicology and Pharmaceutics,Biochemistry,Microbiology

Reference36 articles.

1. Changes in Prevalence of Health Care–Associated Infections in U.S. Hospitals;Magill;N. Engl. J. Med.,2018

2. Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes;Guh;N. Engl. J. Med.,2020

3. CDC (2021). Antibiotic/Antimicrobial Resistance (AR/AMR); Biggest Threats & Data; Clostridioides difficile (C. difficile), Centers for Disesase Control and Prevention.

4. Can we identify patients at high risk of recurrent Clostridium difficile infection?;Kelly;Clin. Microbiol. Infect.,2012

5. Recurrent Clostridium difficile Infection: From Colonization to Cure;Shields;Anaerobe,2015

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