|
1
|
Wright LM, Skinner AM, Cheknis A, McBurney C, Ge L, Pacheco SM, Leehey D, Gerding DN, Johnson S. Effect of the COVID-19 Pandemic on Rates and Epidemiology of Clostridioides difficile Infection in One VA Hospital. Antibiotics (Basel) 2023; 12:1159. [PMID: 37508255 PMCID: PMC10376799 DOI: 10.3390/antibiotics12071159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
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.
Collapse
Affiliation(s)
- Lorinda M. Wright
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
| | - Andrew M. Skinner
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
- Chicago Stritch School of Medicine, Loyola University, 2160 S. First Ave., Maywood, IL 60153, USA
| | - Adam Cheknis
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
| | - Conor McBurney
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
| | - Ling Ge
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
| | - Susan M. Pacheco
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
- Chicago Stritch School of Medicine, Loyola University, 2160 S. First Ave., Maywood, IL 60153, USA
| | - David Leehey
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
- Chicago Stritch School of Medicine, Loyola University, 2160 S. First Ave., Maywood, IL 60153, USA
| | - Dale N. Gerding
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
| | - Stuart Johnson
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
- Chicago Stritch School of Medicine, Loyola University, 2160 S. First Ave., Maywood, IL 60153, USA
| |
Collapse
|
|
2
|
Incidence and Risk Factors for Clostridioides difficile Infections in Non-COVID and COVID-19 Patients: Experience from a Tertiary Care Hospital. Microorganisms 2023; 11:microorganisms11020435. [PMID: 36838400 PMCID: PMC9964032 DOI: 10.3390/microorganisms11020435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
(1) Background: The aim of this study was to assess the incidence and the risk factors for healthcare-associated Clostridioides difficile infection (HA-CDI) in patients with COVID-19 and without this infection. (2) Methods: A single-center, prospective observational study was conducted at the University Clinical Hospital Center in Belgrade, Serbia, from January 2019 to December 2021. The entire hospital was a COVID-dedicated hospital for 12 months during the study period. The incidence density rates and risk factors for HA-CDI in patients with and without COVID-19 are presented. (3) Results: The incidence rates of HA-CDIs were three times higher in patients with COVID-19. The HA-CDI-COVID-patients were younger (69.9 ± 12.6 vs. 72.5 ± 11.6; p = 0.017), admitted from another hospital (20.5% vs. 2.9; p < 0.001), had antimicrobial therapy before CDI (99.1% vs. 91.3%, p < 0.001), received two or more antibiotics (p = 0.030) during a longer period (p = 0.035), received proton pump inhibitors (95.9% vs. 50.0%, p < 0.001) during a longer period (p = 0.012) and steroids (32.8% vs. 20.4%, p < 0.001). During the last month before their current hospitalization, a higher percentage of patients without COVID-19 disease were hospitalized in our hospital (p < 0.001). Independent predictors for HA-CDIs in patients with COVID-19 were admission from another hospital (p = 0.003), the length of antibiotic administration (0.020), and the use of steroids in therapy (p < 0.001). The HA-CDI predictors in the non-COVID patients were older age (p = 0.017), advanced-stage renal failure (p = 0.005), chemotherapy (p = 0.003), and a low albumin level (0.005). (4) Conclusion: Higher incidence rates of HAI-CDIs in COVID-19 patients did not occur due to reduced infection control precautions and hygiene measures but due to antibiotic therapy and therapy with other drugs used during the pandemic.
Collapse
|
|
3
|
Lack of correlation between standardized antimicrobial administration ratios (SAARs) and healthcare-facility–onset Clostridioides difficile infection rates in Veterans Affairs medical facilities. Infect Control Hosp Epidemiol 2022:1-3. [DOI: 10.1017/ice.2022.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Abstract
We detected no correlation between standardized antimicrobial administration ratios (SAARs) and healthcare facility-onset Clostridioides difficile infection (HO-CDI) rates in 102 acute-care Veterans Affairs medical centers over 16 months. SAARs may be useful for investigating trends in local antimicrobial use, but no ratio threshold demarcated HO-CDI risk.
Collapse
|