Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2021; 9(33): 10180-10188
Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10180
Did the severe acute respiratory syndrome-coronavirus 2 pandemic cause an endemic Clostridium difficile infection?
Camelia Cojocariu, Irina Girleanu, Anca Trifan, Andrei Olteanu, Cristina Maria Muzica, Laura Huiban, Stefan Chiriac, Ana Maria Singeap, Tudor Cuciureanu, Catalin Sfarti, Carol Stanciu
Camelia Cojocariu, Irina Girleanu, Anca Trifan, Andrei Olteanu, Cristina Maria Muzica, Laura Huiban, Stefan Chiriac, Ana Maria Singeap, Tudor Cuciureanu, Catalin Sfarti, Carol Stanciu, Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” University Hospital, Institute of Gastroenterology and Hepatology, Iasi 700115, Romania
Author contributions: All authors participated in discussion, writing and/or editing of the manuscript, have read and approved the final version submitted and accept responsibility for its content; Trifan A, Cojocariu C and Stanciu C participated in the design of the review, data collection, analysis and interpretation, manuscript preparation and revision, and approved the final version of the final draft submitted; Huiban L, Olteanu A, Sfarti C, Muzica C, Chiriac S, Cuciureanu T, Girleanu I and Singeap AM performed the acquisition of data and contributed to the drafting of the manuscript; Sfarti C, Muzica C, Huiban L and Girleanu I contributed to the analysis and interpretation of data.
Institutional review board statement: The Institutional Review Board of St Spiridon Hospital, Iasi provided approval for this study.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anca Trifan, FRCP, MD, Teacher, Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” University Hospital, Institute of Gastroenterology and Hepatology, Str. Universității no 16, Iasi 700115, Romania. ancatrifan@yahoo.com
Received: April 28, 2021
Peer-review started: April 28, 2021
First decision: June 23, 2021
Revised: July 23, 2021
Accepted: October 14, 2021
Article in press: October 14, 2021
Published online: November 26, 2021
Processing time: 207 Days and 14.2 Hours
Abstract
BACKGROUND

Clostridium difficile infection (CDI) has increased in prevalence during the last years. The coronavirus disease 2019 (COVID-19) pandemic has negatively influenced patient outcomes. The majority of the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)-infected patients received antibiotics during hospitalization.

AIM

To analyze the factors that influenced CDI development after SARS-CoV-2 infection.

METHODS

Between March 2020 to December 2020, we performed a prospective observational study including 447 patients diagnosed with CDI who were admitted to our tertiary referral university hospital. The diagnosis of CDI was based on the presence of diarrhea (≥ 3 watery stools within 24 h) associated with Clostridium difficile toxins A or B. We excluded patients with other etiology of acute diarrhea.

RESULTS

Among the total 447 (12.5%) patients with CDI, most were male (54.3%) and mean age was 59.7 ± 10.8 years. Seventy-six (17.0%) had history of COVID-19, most being elderly (COVID-19: 62.6 ± 14.6 years vs non-COVID-19: 56.8 ± 17.6 years, P = 0.007), with history of alcohol consumption (43.4% vs 29.4%, P = 0.017), previous hospitalizations (81.6% vs 54.9%, P < 0.001) and antibiotic treatments (60.5% vs 35.5%, P < 0.001), requiring higher doses of vancomycin and prone to recurrent disease (25.0% vs 13.1%, P = 0.011). Age over 60 years [odds ratio (OR): 2.591, 95% confidence interval (CI): 1.452-4.624, P = 0.001], urban residence (OR: 2.330, 95%CI: 1.286-4.221, P = 0.005), previous antibiotic treatments (OR: 1.909, 95%CI: 1.083-3.365, P = 0.025), previous hospitalizations (OR: 2.509, 95%CI: 1.263-4.986, P = 0.009) and alcohol consumption (OR: 2.550, 95%CI: 1.459-4.459, P = 0.001) were risk factors of CDI in COVID-19.

CONCLUSION

CDI risk is unrelated to history of SARS-CoV-2 infection. However, previous COVID-19 may necessitate higher doses of vancomycin for CDI.

Keywords: COVID-19 infection; Clostridium difficile infection; Risk factors; Antibiotic use; Pandemic; Recurrence

Core Tip: The coronavirus disease 2019 (COVID-19) pandemic was associated with an increased prevalence of Clostridium difficile (C. difficile) infections. Previous hospitalization and antibiotic treatment are known risk factors for C. difficile infection. Patients with a past history of COVID-19 infection, however, required higher doses of vancomycin and were more prone to developing recurrent disease. Rational antibiotic use should be implemented in all patients with COVID-19 infection. Diarrhea is a symptom of COVID-19 infection, which could delay the diagnosis of C. difficile infection. All the patients should be tested for C. difficile toxins A and B if watery diarrhea develops.