Eliza Manea, Raluca Jipa, Alexandru Milea, Antonia Roman, Georgiana Neagu, Adriana Hristea
{"title":"Healthcare-associated <i>Clostridioides difficile</i> infection during the COVID-19 pandemic in a tertiary care hospital in Romania.","authors":"Eliza Manea, Raluca Jipa, Alexandru Milea, Antonia Roman, Georgiana Neagu, Adriana Hristea","doi":"10.2478/rjim-2021-0020","DOIUrl":null,"url":null,"abstract":"<p><p><b>Introduction.</b> Information on healthcare-associated <i>C.difficile</i> infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic. <b>Methods.</b> We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017-2018. <b>Results.</b> We found 51 cases during 2020-2021 (COVID-19 group), incidence 5.6/1000 adult discharge and 99 cases during 2017-2018 (pre-COVID-19 group), incidence 6.1/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days). Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment - mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group. <b>Conclusions.</b> The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017-2018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"59 4","pages":"409-415"},"PeriodicalIF":1.6000,"publicationDate":"2021-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"9","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Romanian Journal of Internal Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2478/rjim-2021-0020","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/12/1 0:00:00","PubModel":"Print","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 9
Abstract
Introduction. Information on healthcare-associated C.difficile infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic. Methods. We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017-2018. Results. We found 51 cases during 2020-2021 (COVID-19 group), incidence 5.6/1000 adult discharge and 99 cases during 2017-2018 (pre-COVID-19 group), incidence 6.1/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days). Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment - mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group. Conclusions. The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017-2018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19.