Impact of COVID19 pandemic on the incidence of health-care associated Clostridioides difficile infection

Nicolás Merchante, Pablo Chico, Esther Márquez-Saavedra, Gerónima Riera, Rocío Herrero, Pilar González-de-la-Aleja, Ana I Aller, Juan Carlos Rodríguez, Miguel Rodríguez-Fernández, José Manuel Ramos, Marta Trigo-Rodríguez, Esperanza Merino, Nicolás Merchante, Pablo Chico, Esther Márquez-Saavedra, Gerónima Riera, Rocío Herrero, Pilar González-de-la-Aleja, Ana I Aller, Juan Carlos Rodríguez, Miguel Rodríguez-Fernández, José Manuel Ramos, Marta Trigo-Rodríguez, Esperanza Merino

Abstract

Objective: To investigate the impact of COVID19 pandemic on the incidence of health-care associated Clostridioides difficile infection (HA-CDI).

Methods: Retrospective study conducted in the Hospital Universitario de Valme (HUV) and the Hospital General Universitario de Alicante (HGUA) in Spain between January 2019 and February 2021. The study period was divided into non-COVID19 period (2019 and months from 2020 to 2021 with ≤30 hospitalized COVID19 patients) and COVID19 period (months from 2020 to 2021 with >30 COVID19 patients). HA-CDI incidence rates (IR) were calculated as the number of new CDI cases per 10.000 occupied bed-days (OBD) and antimicrobial consumption by means of the defined daily dose (DDD) per 1000 OBD.

Results: During the COVID19 period, HA-CDI IR in the HUV was 2.6 per 10.000 OBD, which was lower than what was observed during the non-COVID19 period (4.1 per 10.000 OBD; p = 0.1). In the HGUA, HA-CDI IR during COVID19 period was 3.9 per 10.000 OBD, which was not significantly different to the IR observed during the non-COVID19 period (3.7 per 10.000 OBD; p = 0.8). There was a slight increase in the total antibiotic consumption during COVID19 period in both hospitals, with significant increases of certain high-risk antibiotics as cephalosporins.

Conclsusions: HA-CDI incidence has not increased during the COVID19 pandemic in two tertiary centers in Spain, in spite of a slightly higher antibiotic consumption during the COVID19 period in both hospitals. These findings suggest that, in the presence of strict infection control measures, hospital antibiotic consumption might have a lower impact than expected on HA-CDI.

Keywords: Antimicrobial stewardship; Clostridioides difficile; Covid-19; Health-care associated infections; SARS-CoV-2.

Conflict of interest statement

Declaration of competing interest The authors declare that they have no competing interests.

Copyright © 2022 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Number of hospitalizations due to COVID19 in the participant hospitals. 1A: Hospital Universitario de Valme (HUV). 1B: Hospital General Universitario de Alicante (HGUA). COVID19: Coronavirus disease 2019. ICU: Intensive care unit.
Fig. 2
Fig. 2
Trends in total antibiotic consumption and HA-CDI incidence during the study period. 2A: Hospital Universitario de Valme (HUV). 2B: Hospital General Universitario de Alicante (HGUA). DDD: Daily defined dose. HA-CDI: Health-care associated Clostridoides difficile infection. OBD: occupied bed-days. CDI: Clostridoides difficile infection.
Fig. 3
Fig. 3
Trends in total antibiotic consumption and HO-HCFA incidence in Hospital Universitario de Valme during 2020–2021. DDD: Daily defined dose. HO-HCFA: Hospital-onset healthcare facility-associated Clostridoides difficile infection. OBD: occupied bed-days. CDI: Clostridoides difficile infection.
Fig. 4
Fig. 4
Antibiotic consumption by study period. 4A: Hospital Universitario de Valme (HUV). 4B: Hospital General Universitario de Alicante (HGUA). ATB: Antibiotics. COVID19: Coronavirus disease 2019. DDD: Daily defined dose. OBD: occupied bed-days. Pip/Taz: Piperacilin/Tazobactam.

References

    1. Lessa F.C., Mu Y., Bamberg W.M., Beldavs Z.G., Dumyati G., Dunn J.R., et al. Burden of Clostridium difficile infection in the United States. N. Engl. J. Med. 2015;372:825–834. doi: 10.1056/NEJMoa1408913.
    1. Davies K.A., Longshaw C.M., Davis G.L., Bouza E., Barbut F., Barna Z., et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicenter, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalized patients with diarrhea (EUCLID) Lancet Infect. Dis. 2014;14:1208–1219. doi: 10.1016/S1473-3099(14)70991-0.
    1. Longo D.L., Leffler D.A., Lamont J.T. Clostridium difficile infection. N. Engl. J. Med. 2015;372:1539–1548. doi: 10.1056/NEJMra1403772.
    1. Tschudin-Sutter S., Kuijper E.J., Durovic A., Vehreschild M.J.G.T., Barbut F., Eckert C., et al. Guidance document for prevention of Clostridium difficile infection in acute healthcare settings. Clin. Microbiol. Infect. 2018;24:1051–1054. doi: 10.1016/j.cmi.2018.02.020. Epub 2018 Mar 2.
    1. Spigaglia P. COVID-19 and Clostridioides difficile infection (CDI): possible implications for elderly patients. Anaerobe. 2020;64:102233. doi: 10.1016/j.anaerobe.2020.102233.
    1. Luo Y., Grinspan L.T., Fu Y., Adams-Sommer V., Willey D.K., Patel G., et al. Hospital-onset Clostridoides difficile infections during the COVID-19 pandemic. Infect. Control Hosp. Epidemiol. 2021;42:1165–1166. doi: 10.1017/ice.2020.1223.
    1. Wee L.E.I., Conceicao E.P., Tan J.Y., Magesparan K.D., Amin I.B.M., Ismail B.B.S., et al. Unintended consequences of infection prevention and control measures during COVID-19 pandemic. Am. J. Infect. Control. 2021;49:469–477. doi: 10.1016/j.ajic.2020.10.019.
    1. Baker M.A., Sands K.E., Huang S.S., Kleinman K., Septimus E.J., Varma N., et al. The impact of COVID-19 on healthcare-associated infections. Clin. Infect. Dis. 2021 doi: 10.1093/cid/ciab688. Aug9; ciab688, Online ahead of print. doi: 10.1093/cid/ciab688.
    1. Ponce-Alonso M., Sáez de la Fuente J., Rincón-Carlavilla A., Moreno-Nuñez P., Martínez-García L., Escudero-Sánchez R., et al. Impact of the coronavirus disease 2019 (COVID-19) pandemic on nosocomial Clostridioides difficile infection. Infect. Control Hosp. Epidemiol. 2021;42:406–410. doi: 10.1017/ice.2020.454.
    1. Hazel K., Skally M., Glynn E., Foley M., Burns K., O'Toole A., et al. The other ‘C’: hospital-acquired Clostridioides difficile infection during coronavirus disease 2019 (COVID-19) pandemic. Infect. Control Hosp. Epidemiol. 2021:1–2. doi: 10.1017/ice.2021.3. Jan 13. 10.1017/ice.2021.3. Online ahead of print.
    1. Bentivegna E., Alessio G., Spuntarelli V., Luciani M., Santino I., Simmaco M., et al. Impact of COVID-19 prevention measures on risk of health care-associated Clostridium difficile infection. Am. J. Infect. Control. 2021;49:640–642. doi: 10.1016/j.ajic.2020.09.010.
    1. Ochoa-Hein E., Rajme-López S., Rodríguez-Aldama J.C., Huertas-Jiménez M.A., Chávez-Ríos A.R., Paz-García P., et al. Substantial reduction of healthcare facility-onset Clostridoides difficile infection (HO-CDI) rates after conversion of a hospital for exclusive treatment of COVID-19 patients. Am. J. Infect. Control. 2021;49:966–968. doi: 10.1016/j.ajic.2020.12.008.
    1. European Centre for Disease Prevention and Control . ECDC; Stockholm: 2019. European Surveillance of Clostridioides (Clostridium) Difficile Infections. Surveillance Protocol Version 2.4. Available at: .
    1. Crobach M.J., Planche T., Eckert C., Barbut F., Terveer E.M., Dekkers O.M., et al. European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clin. Microbiol. Infect. 2016;22:S63–S81. doi: 10.1016/j.cmi.2016.03.010.
    1. van Prehn J., Reigadas E., Vogelzang E.H., Bouza E., Hristea A., Guery B., et al. European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults. Clin. Microbiol. Infect. 2021;(21) doi: 10.1016/j.cmi.2021.09.038. Oct 19;S1198-743X. 00568-1, (Online ahead of print)
    1. Mc Donald C.L., Gerding D.N., Johnson S., Bakken J.S., Carrol K.C., Coffin S.E., et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the infectious diseases society of America (IDSA) and society for healthcare epidemiology of America (SHEA) Clin. Infect. Dis. 2018;66:987–994. doi: 10.1093/cid/ciy149.
    1. World Health Organization Collaborating Center for Drug Statistics Method- ology, Norwegian Institute of Public Health . 2018. Definition and General Considerations: Defined Daily Dose (DDD) Available at:
    1. Brown K.A., Langford B., Schwartz K.L., Diong C., Garber G., Daneman N. Antibiotic prescribing choices and their comparative C.difficile infection risks: a longitudinal case-cohort study. Clin. Infect. Dis. 2021;72:836–844. doi: 10.1093/cid/ciaa124.
    1. Webb B.J., Subramanian A., Lopansri B., Goodman B., Jones P.B., Ferraro J., et al. Antibiotic exposure and risk for hospital-associated Clostridioides difficile infection. Antimicrob. Agents Chemother. 2020;64 doi: 10.1128/AAC.02169-19. e01269–19.
    1. Lawes T., Lopez-Lozano J.M., Nebot C.A., Macartney G., Subbarao-Sharma R., Wares K.D., et al. Effect of a national 4C antibiotic stewardship intervention on the clinical and molecular epidemiology of Clostridium difficile infections in a region of Scotland: a non-linear time-series analysis. Lancet Infect. Dis. 2017;17:194–206. doi: 10.1016/S1473-3099(16)30397-8.
    1. Kazakova S.V., Baggs J., Mc Donald L.C., Yi S.H., Hatfield K.M., Guh A., et al. Association between antibiotic use and hospital-onset Clostridioides difficile infection in US acute care hospitals, 2006-2012: an ecologic analysis. Clin. Infect. Dis. 2020;70:11–18. doi: 10.1093/cid/ciz169.
    1. Kazakova S.V., Baggs J., Yi S.H., Reddy S.C., Hatfield K.M., Guh A.Y., et al. Associations of facility-level antibiotic use and hospital-onset Clostridioides difficile infection in US acute-care hospitals. Infect. Control Hosp. Epidemiol. 2021;7:1–3. doi: 10.1017/ice.2021.151. 2012–2018.
    1. Rodriguez-Baño J., Pérez-Moreno M.A., Peñalva G., Garnacho-Montero J., Pinto C., Salcedo I., et al. Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis. Clin. Microbiol. Infect. 2020;26:358–365. doi: 10.1016/j.cmi.2019.07.009.
    1. Kim B., Kim J., Pai H. Association between antibiotic consumption and incidence of Clostridioides difficile infection in a hospital. J. Kor. Med. Sci. 2020;35(47):e407. doi: 10.3346/jkms.2020.35.e407.

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