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1.
Medicina (Kaunas) ; 58(9)2022 Sep 12.
Article in English | MEDLINE | ID: covidwho-2033055

ABSTRACT

Background: This study aimed to investigate the clinical form, risk factors, and outcomes of patients with COVID-19 and Clostridioides difficile co-infections. Methods: This retrospective study (2 September 2021-1 April 2022) included all patients with Clostridioides difficile infection (CDI) and COVID-19 infection who were admitted to the Covid Hospital of the University Clinical Center of Vojvodina. Results: A total of 5124 COVID-19 patients were admitted to the Covid Hospital, and 326 of them (6.36%) developed hospital-onset CDI. Of those, 326 of the CDI patients (88.65%) were older than 65 years. The median time of CDI onset was 12.88 days. Previous hospitalizations showed 69.93% of CDI patients compared to 38.81% in the non-CDI group (p = 0.029). The concomitant antibiotics exposure was higher among the CDI group versus the non-CDI group (88.65% vs. 68.42%, p = 0.037). Albumin levels were ≤ 25 g/L among 39.57% of the CDI patients and 21.71% in the non-CDI patients (p = 0.021). The clinical manifestations of CDI ranged from mild diarrhea (26.9%) to severe diarrhea (63.49%) and a complicated form of colitis (9.81%). Regarding outcomes, 79.14% of the CDI patients recovered and 20.86% had fatal outcomes in-hospital. Although a minority of the patients were in the non-CDI group, the difference in mortality rate between the CDI and non-CDI group was not statistically significant (20.86% vs. 15.13%, p = 0.097). Conclusions: Elderly patients on concomitant antibiotic treatments with hypoalbuminemia and with previous healthcare exposures were the most affected by COVID-19 and CD co-infections.


Subject(s)
COVID-19 , Clostridioides difficile , Clostridium Infections , Coinfection , Aged , Albumins , Anti-Bacterial Agents/therapeutic use , COVID-19/complications , Clostridium Infections/complications , Clostridium Infections/drug therapy , Clostridium Infections/epidemiology , Coinfection/epidemiology , Diarrhea/epidemiology , Diarrhea/etiology , Hospitals , Humans , Retrospective Studies , Serbia/epidemiology , Universities , Yugoslavia
2.
Medicine (Baltimore) ; 101(27): e29823, 2022 Jul 08.
Article in English | MEDLINE | ID: covidwho-1927463

ABSTRACT

Beside the changes in the gut microbiota in context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the increased use of high-risk broad-spectrum antibiotics during the actual pandemic raises concerns about a possible increase of Clostridioides difficile infections (CDIs). We retrospectively analyzed 80 consecutive patients, with SARS-CoV-2 pneumonia and CDI. The mean length of hospitalization was 19.63 days. The mean time of the onset of the digestive symptoms related to CDI was 5.16 days. Patients with an onset of the digestive symptoms from hospital admission have a significantly lower median length in hospital stay. The recovered patients present a statistically significant decreased median age. coronavirus disease 2019 (COVID-19) cured patients present CDI symptoms much earlier than the deceased patients, when comparing the median days before the occurrence of any digestive symptoms regarding CDI. Among the patients that prior to their hospitalization for COVID-19 were exposed to antibiotics, 54.7% presented CDI digestive symptoms during their hospitalization and 65.6% had a severe or critical COVID-19 form. Although the incidence of CDI in the pandemic is lower compared to the period before the pandemic, the severity of cases and the death rate increased. In the actual setting clinicians need to be aware of possible CDI and SARS-CoV-2 co-infection.


Subject(s)
COVID-19 , Clostridioides difficile , Clostridium Infections , Coinfection , Cross Infection , Anti-Bacterial Agents/therapeutic use , COVID-19/epidemiology , Clostridium Infections/drug therapy , Clostridium Infections/epidemiology , Coinfection/drug therapy , Coinfection/epidemiology , Cross Infection/drug therapy , Humans , Retrospective Studies , SARS-CoV-2
3.
Am J Health Syst Pharm ; 79(19): 1663-1673, 2022 09 22.
Article in English | MEDLINE | ID: covidwho-1908742

ABSTRACT

PURPOSE: A systematic review was performed to determine if remote stewardship (telestewardship) provides clinical and fiscal benefit and is a feasible alternative to local stewardship programs. SUMMARY: Antibiotic resistance is an increasingly important national and global threat. US regulators have made antimicrobial stewardship programs a condition of participation in federally funded healthcare programs, and stewardship programs are surveyed during accreditation visits. Small and rural hospitals are at risk for stewardship noncompliance because lack of resources limits comprehensive stewardship program implementation. Remote stewardship programs are established to remedy this area of partial compliance. To characterize the impact of remote stewardship on selected clinical and fiscal outcomes, PubMed was searched for studies involving telestewardship that reported data on antimicrobial utilization, patient length of stay, mortality, bacterial susceptibility, hospital-acquired Clostridioides difficile infection (HA-CDI), and/or antimicrobial costs. A systematic approach was used to screen study titles, abstracts, and content and data extracted. Study quality was analyzed using Cochrane risk-of-bias assessment tools. Fourteen studies were included in the final review. Collectively, the antimicrobial utilization data was positive, with utilization of targeted antimicrobials decreasing after telestewardship implementation. Mixed (both positive and neutral) results were found for patient length of stay, mortality, and HA-CDI rates. Fiscal outcomes were consistently positive. CONCLUSION: Based on the reviewed evidence, remote antimicrobial stewardship programs may aid in the more judicious use of antimicrobials by decreasing utilization rates. More studies are needed to clarify patient-oriented outcomes. Telestewardship has positive effects in terms of cost savings, although savings may be offset by the structure of the program.


Subject(s)
Anti-Infective Agents , Antimicrobial Stewardship , Clostridium Infections , Anti-Bacterial Agents/therapeutic use , Clostridium Infections/drug therapy , Hospitals, Rural , Humans
4.
Anaerobe ; 75: 102579, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1814098

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.


Subject(s)
COVID-19 , Clostridioides difficile , Clostridium Infections , Cross Infection , Anti-Bacterial Agents/therapeutic use , COVID-19/epidemiology , Clostridium Infections/drug therapy , Clostridium Infections/epidemiology , Cross Infection/drug therapy , Cross Infection/epidemiology , Humans , Incidence , Pandemics , Retrospective Studies
5.
Anaerobe ; 74: 102518, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1637978

ABSTRACT

The ongoing coronavirus disease (COVID-19) pandemic has dramatically tested healthcare systems around the world, with serious repercussions on the measures of prevention and control of hospital-acquired infections (HAIs). Among HAIs, Clostridioides difficile infection (CDI) represents one of the most important global public health threats. Although the full impact of the COVID-19 pandemic on CDI remains undetermined, depending on the development of the pandemic in the coming months, in this review literature studies of the last three years have been considered in order to depict the current situation, and make some considerations about possible future developments. If on the one hand, a general reduction in CDI incidence has been reported in several settings, mainly due to the extraordinary reinforcement of infection prevention measures, on the other hand, the critical circumstances experienced in many hospitals have limited the effectiveness of these measures, particularly in the intensive care units (ICUs), increasing the possibility of the occurrence of hospital-acquired CDI (HA-CDI). New concerns have arisen from the decrease in C. difficile testing and the increased use of broad-spectrum antibiotics reported during the pandemic. In particular, overuse of antibiotics and disinfectants may lead to a selection of resistant C. difficile strains not only in hospitals but also in the community. Furthermore, patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and patients that have survived COVID-19 may represent a new group of frail patients potentially at a higher risk of CDI, a group that could potentially increase in size due to SARS-CoV-2 evolution. In the dramatic COVID-19 era, the multifactorial nature of CDI has emerged more clearly than before, highlighting the necessity of a strong refocus on efforts to improve prevention strategies and to integrate CDI surveillance in a One Health prospective in order to curtail the public health threat posed by this infection in the next future.


Subject(s)
COVID-19 , Clostridioides difficile , Clostridium Infections , Cross Infection , Anti-Bacterial Agents/therapeutic use , COVID-19/epidemiology , Clostridium Infections/drug therapy , Clostridium Infections/epidemiology , Clostridium Infections/prevention & control , Cross Infection/drug therapy , Cross Infection/epidemiology , Cross Infection/prevention & control , Humans , Pandemics , Prospective Studies , SARS-CoV-2
6.
Int J Antimicrob Agents ; 58(6): 106453, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1466380

ABSTRACT

OBJECTIVES: This retrospective cohort study examined the impact of the pandemic on antimicrobial use (AU) in South Carolina hospitals. METHODS: Antimicrobial use in days of therapy (DOT) per 1000 days-present was evaluated in 17 hospitals in South Carolina. Matched-pairs mean difference was used to compare AU during the pandemic (March-June 2020) with that during the same months in 2019 in hospitals that did and did not admit patients with COVID-19. RESULTS: There was a 6.6% increase in overall AU in the seven hospitals that admitted patients with COVID-19 (from 530.9 to 565.8; mean difference (MD) 34.9 DOT/1000 days-present; 95% CI 4.3, 65.6; P = 0.03). There was no significant change in overall AU in the remaining 10 hospitals that did not admit patients with COVID-19 (MD 6.0 DOT/1000 days-present; 95% CI -55.5, 67.6; P = 0.83). Most of the increase in AU in the seven hospitals that admitted patients with COVID-19 was observed in broad-spectrum antimicrobial agents. A 16.4% increase was observed in agents predominantly used for hospital-onset infections (from 122.3 to 142.5; MD 20.1 DOT/1000 days-present; 95% CI 11.1, 29.1; P = 0.002). There was also a 9.9% increase in the use of anti-methicillin-resistant Staphylococcus aureus (MRSA) agents (from 66.7 to 73.3; MD 6.6 DOT/1000 days-present; 95% CI 2.3, 10.8; P = 0.01). CONCLUSION: The COVID-19 pandemic appears to drive overall and broad-spectrum antimicrobial use in South Carolina hospitals admitting patients with COVID-19. Additional antimicrobial stewardship resources are needed to curtail excessive antimicrobial use in hospitals to prevent subsequent increases in antimicrobial resistance and Clostridioides difficile infection rates, given the continuing nature of the pandemic.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Cross Infection/drug therapy , Drug Utilization Review/statistics & numerical data , Pandemics , Antimicrobial Stewardship , COVID-19 , Clostridium Infections/drug therapy , Hospitals , Humans , Methicillin-Resistant Staphylococcus aureus/drug effects , Retrospective Studies , SARS-CoV-2 , South Carolina
7.
BMJ Open ; 11(6): e046480, 2021 06 29.
Article in English | MEDLINE | ID: covidwho-1288391

ABSTRACT

INTRODUCTION: Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the USA, having high incidence in intensive care units (ICU). Antibiotic use increases risk of CDI, with fluoroquinolones (FQs) particularly implicated. In healthcare settings, antibiotic stewardship (AS) and infection control interventions are effective in CDI control, but there is little evidence regarding the most effective AS interventions. Preprescription authorisation (PPA) restricting FQs is a potentially promising AS intervention to reduce CDI. The FQ Restriction for the Prevention of CDI (FIRST) trial will evaluate the effectiveness of an FQ PPA intervention in reducing CDI rates in adult ICUs compared with preintervention care, and evaluate implementation effectiveness using a human-factors and systems engineering model. METHODS AND ANALYSIS: This is a multisite, stepped-wedge, cluster, effectiveness-implementation clinical trial. The trial will take place in 12 adult medical-surgical ICUs with ≥10 beds, using Epic as electronic health record (EHR) and pre-existing AS programmes. Sites will receive facilitated implementation support over the 15-month trial period, succeeded by 9 months of follow-up. The intervention comprises a clinical decision support system for FQ PPA, integrated into the site EHRs. Each ICU will be considered a single site and all ICU admissions included in the analysis. Clinical data will be extracted from EHRs throughout the trial and compared with the corresponding pretrial period, which will constitute the baseline for statistical analysis. Outcomes will include ICU-onset CDI rates, FQ days of therapy (DOT), alternative antibiotic DOT, average length of stay and hospital mortality. The study team will also collect implementation data to assess implementation effectiveness using the Systems Engineering Initiative for Patient Safety model. ETHICS AND DISSEMINATION: The trial was approved by the Institutional Review Board at the University of Wisconsin-Madison (2018-0852-CP015). Results will be made available to participating sites, funders, infectious disease societies, critical care societies and other researchers. TRIAL REGISTRATION NUMBER: NCT03848689.


Subject(s)
Clostridioides difficile , Clostridium Infections , Adult , Clostridioides , Clostridium Infections/drug therapy , Clostridium Infections/epidemiology , Clostridium Infections/prevention & control , Fluoroquinolones/therapeutic use , Humans , Intensive Care Units
8.
Rom J Intern Med ; 59(4): 409-415, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1247777

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.


Subject(s)
COVID-19 , Clostridioides difficile/isolation & purification , Clostridium Infections/epidemiology , Cross Infection/epidemiology , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/therapeutic use , Cephalosporins/therapeutic use , Clostridium Infections/drug therapy , Cross Infection/drug therapy , Delivery of Health Care , Humans , Pandemics , Retrospective Studies , Risk Factors , Romania/epidemiology , SARS-CoV-2 , Tertiary Care Centers
9.
Anaerobe ; 70: 102384, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1240162

ABSTRACT

Testing for and incidence of Clostridioides difficile infection (CDI) was examined at a single center before and during the first surge of the COVID-19 pandemic. Incidence of CDI remained stable but testing statistically significantly decreased during the first surge despite an increase in antibiotic use. There were no new CDI-focused antimicrobial stewardship interventions introduced during this time.


Subject(s)
COVID-19/epidemiology , Clostridioides difficile/physiology , Clostridium Infections/diagnosis , Anti-Bacterial Agents/therapeutic use , Antimicrobial Stewardship , Clostridioides difficile/drug effects , Clostridioides difficile/genetics , Clostridioides difficile/isolation & purification , Clostridium Infections/drug therapy , Clostridium Infections/epidemiology , Clostridium Infections/microbiology , Humans , Pandemics
10.
Am J Gastroenterol ; 115(8): 1153-1155, 2020 08.
Article in English | MEDLINE | ID: covidwho-525850

Subject(s)
Coronavirus Infections/physiopathology , Digestive System Diseases/physiopathology , Pneumonia, Viral/physiopathology , Abdominal Pain/etiology , Abdominal Pain/metabolism , Abdominal Pain/physiopathology , Abdominal Pain/therapy , Ambulatory Care , Anorexia/etiology , Anorexia/metabolism , Anorexia/physiopathology , Anorexia/therapy , Anti-Bacterial Agents/adverse effects , Antipyretics/adverse effects , Antiviral Agents/adverse effects , Betacoronavirus , COVID-19 , Chemical and Drug Induced Liver Injury/etiology , Chemical and Drug Induced Liver Injury/metabolism , Chemical and Drug Induced Liver Injury/physiopathology , Chemical and Drug Induced Liver Injury/therapy , China , Clostridium Infections/diagnosis , Clostridium Infections/drug therapy , Coronavirus Infections/complications , Coronavirus Infections/metabolism , Coronavirus Infections/therapy , Diarrhea/etiology , Diarrhea/metabolism , Diarrhea/physiopathology , Diarrhea/therapy , Digestive System Diseases/etiology , Digestive System Diseases/metabolism , Digestive System Diseases/therapy , Endoscopy, Digestive System , Gastroenterology , Humans , Liver Diseases/etiology , Liver Diseases/metabolism , Liver Diseases/physiopathology , Liver Diseases/therapy , Nausea/etiology , Nausea/metabolism , Nausea/physiopathology , Nausea/therapy , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/metabolism , Pneumonia, Viral/therapy , Probiotics/therapeutic use , SARS-CoV-2 , Societies, Medical , Vomiting/etiology
11.
Anaerobe ; 64: 102233, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-620931

ABSTRACT

COVID-19 dramatically affects the elderly. Due to the large usage of antibiotics during the current pandemic and the gastrointestinal manifestations of COVID-19, the elderly population, hospitalized patients, residents in LTCFs and persons that survived the COVID-19 might be more prone to Clostridioides difficile infections (CDI). A renewed attention to CDI is necessary during the ongoing COVID-19 pandemic.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Clostridium Infections/drug therapy , Coronavirus Infections/drug therapy , Gastroenteritis/drug therapy , Pneumonia, Viral/drug therapy , Aged , Aged, 80 and over , Betacoronavirus/drug effects , COVID-19 , Clostridioides difficile/drug effects , Clostridium Infections/pathology , Coronavirus Infections/mortality , Coronavirus Infections/pathology , Gastroenteritis/microbiology , Gastroenteritis/pathology , Gastrointestinal Tract/microbiology , Gastrointestinal Tract/pathology , Humans , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/pathology , SARS-CoV-2
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