Hospital-Onset CDI Increased With COVID-19 at Tertiary Care Hospital

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) increased the risk of hospital-onset Clostridioides difficile infection (CDI) at a tertiary care referral hospital in Missouri during the early months of the pandemic, according to a study published in the American Journal of Infection Control. 

“Compared to 2017, year 2020 admissions with SARS-CoV-2 had an odds ratio (OR) for hospital-onset CDI of 2.19 (95% CI 1.07, 4.48), while year 2020 admissions without SARS-CoV-2 had an OR of 1.20 (95% CI 0.93, 1.55),” wrote corresponding author Jason P. Burnham, MD, of the Washington University in St. Louis School of Medicine, and coauthors.

The retrospective study investigated risk factors for hospital-onset CDI in patients from 2017 until the start of the pandemic and during the early months of the pandemic through August 2020 at three Missouri hospitals. 

Two smaller community hospitals in the study had just two hospital-onset CDI cases during the pandemic. The third facility, a large tertiary referral hospital, had eight patients with SARS-CoV-2 and hospital-onset CDI. Consequently, researchers limited analyses to the tertiary care hospital.

At the tertiary care hospital, hospital-onset CDI was more common during the pandemic than in the preceding years, according to the study. In addition to year of hospitalization and SARS-CoV-2 infection, risk factors associated with hospital-onset CDI included older age, chronic comorbidities, high-risk antibiotic use, and acid-reducing medications. Low-risk antibiotics and fluoroquinolones were not linked with hospital-onset CDI.

“Our study is limited by the small number of hospital-onset CDI cases in the early pandemic. It is possible a larger dataset might find differences in risk factors for hospital-onset CDI at the community hospitals,” researchers wrote. “In addition, it is possible that risk factors for hospital-onset CDI are different between community and tertiary care hospitals, something we were unable to capture due to infrequent hospital-onset CDI at the community hospitals.”

Reference:
Kwon JH, Nickel KB, Reske KA, et al. Risk factors for hospital-onset Clostridioides difficile infections before and during the severe acute respiratory syndrome coronavirus 2 pandemic. Am J Infect Control. Published online May 30, 2023. doi:10.1016/j.ajic.2023.05.015