COVID-19 Outcomes Worse With Simultaneous CDI

US patients with concurrent COVID-19 and Clostridioides difficile infection (CDI) had worse in-hospital mortality and morbidity compared with patients with COVID-19 without CDI, according to a study published in Infectious Disease Reports.

“CDI was on the rise during the COVID-19 pandemic due to various reasons such as poor antibiotic stewardship and neglecting hand hygiene due to the overburdened health care system,” wrote corresponding author Abu Baker Sheikh, MD, of the University of New Mexico Health Sciences Center in Albuquerque, and study coauthors. “We recommend adopting strict infection prevention protocols across all clinical settings as they are the biggest nidus for harboring C. difficile and contracting COVID-19 infection.”

The retrospective study used a national inpatient database to identify 1.7 million patients with COVID-19, among whom 10,710 patients, or 0.6%, also had simultaneous CDI. Researchers were interested in how concurrent infection with both COVID-19 and CDI affected patient outcomes.

Patients with both conditions had higher rates of in-hospital mortality and complications, the study found. In patients with COVID-19 and CDI, the mortality rate was 23%, compared with 13.4% for patients with COVID-19 but no CDI. Regarding in-hospital complications, rates of ileus were 2.7% and septic shock were 21% in patients with both conditions. Rates of ileus were 0.8% and septic shock were 7.2% in patients with COVID-19 without CDI. Rates of viscus perforation, acute kidney injury, acute kidney injury requiring hemodialysis, and mechanical ventilation were also higher with concurrent COVID-19 and CDI.

Average lengths of stay and overall hospitalization costs were also higher with both conditions: 15.1 days and USD 196,012, researchers reported, compared with 8 days and USD 91,162 with COVID-19 without CDI.

“Furthermore, we also observed that most of the patients with CDI and COVID-19 required some form of placement post discharge such as skilled nursing facility/long-term acute care/nursing home, which further led to increased health care costs and load…,” the authors wrote. “Therefore, from a financial and logistics standpoint, it is imperative to curb this rising incidence of CDI and COVID-19.”

Reference:
Awan RU, Gangu K, Nguyen A, et al. COVID-19 and Clostridioides difficile coinfection outcomes among hospitalized patients in the united states: an insight from national inpatient database. Infect Dis Rep. 2023;15(3):279-291. doi:10.3390/idr15030028