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1.
BMC Infect Dis ; 22(1): 739, 2022 Sep 16.
Article in English | MEDLINE | ID: covidwho-2038668

ABSTRACT

BACKGROUND: Healthcare-associated infection (HAI) is a common and largely preventable cause of morbidity and mortality. The COVID-19 pandemic has presented unprecedented challenges to health systems. We conducted a national survey to ascertain hospital characteristics and the use of HAI prevention measures in Israel. METHODS: We e-mailed surveys to infection prevention and control (IPC) leads of acute care hospitals in Israel. The survey included questions about the use of practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI). The survey also assessed COVID-19 impact and healthcare worker well-being. RESULTS: IPC leads from 15 of 24 invited hospitals (63%) completed the survey. Only one-third of respondents reported strong support for IPC from hospital leadership. Although several prevention practices were used by all hospitals (e.g., maximum sterile barrier precautions for CLABSI and real-time assessment of environmental cleaning for CDI), use of other practices was suboptimal-particularly for CAUTI and VAP. COVID-19 had a profound impact on Israeli hospitals, with all hospitals reporting opening of new units to care for COVID patients and most reporting moderate to extreme financial hardship. All hospitals reported highly successful plans to vaccinate all staff and felt confident that the vaccine is safe and effective. CONCLUSION: We provide a status report of the IPC characteristics and practices Israeli hospitals are currently using to prevent HAIs during the COVID-19 era. While many globally accepted IPC practices are widely implemented, opportunities to increase the use of certain IPC practices in Israeli hospitals exist.


Subject(s)
COVID-19 , Catheter-Related Infections , Clostridium Infections , Cross Infection , Pneumonia, Ventilator-Associated , Urinary Tract Infections , COVID-19/epidemiology , COVID-19/prevention & control , Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Clostridium Infections/epidemiology , Clostridium Infections/prevention & control , Cross Infection/epidemiology , Cross Infection/prevention & control , Delivery of Health Care , Humans , Israel/epidemiology , Pandemics/prevention & control , Pneumonia, Ventilator-Associated/epidemiology , Pneumonia, Ventilator-Associated/prevention & control , Urinary Tract Infections/epidemiology , Urinary Tract Infections/prevention & control
2.
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
3.
Future Microbiol ; 17: 653-663, 2022 06.
Article in English | MEDLINE | ID: covidwho-1974548

ABSTRACT

Aim: To assess the impact of Clostridioides difficile infection on the course of COVID-19. Methods: The authors included 809 patients with COVID-19 in this retrospective study: 55 had C. difficile infection, 23 had C. difficile-negative antibiotic-associated diarrhea and 731 had no diarrhea. C. difficile in feces was determined by immunochromatographic test for its toxins. Results: C. difficile infection was associated with increased risk of death (hazard ratio = 2.6; p = 0.021), especially after 20 days of disease (hazard ratio = 6.5; p < 0.001). C. difficile infection-associated diarrhea was longer and more severe than C. difficile-negative antibiotic-associated diarrhea. Unlike patients with C. difficile-negative antibiotic-associated diarrhea, patients with C. difficile infection were admitted to the intensive care unit and needed mechanical ventilation more often than those without diarrhea. Conclusion: C. difficile infection worsens the course and prognosis of COVID-19.


Patients with COVID-19 usually receive antibiotic treatment, which predisposes them to antibiotic-associated diarrhea. In some cases, antibiotic-associated diarrhea can be caused by Clostridioides difficile bacteria. To learn more about the impact of C. difficile infection on COVID-19, the authors analyzed data from the medical records of 809 patients with COVID-19. The authors found that C. difficile co-infection worsens the course and prognosis of COVID-19. The authors suggest that patients with COVID-19 who develop diarrhea after taking antibiotics be tested for C. difficile and treated for this co-infection if the test is positive.


Subject(s)
COVID-19 , Clostridioides difficile , Clostridium Infections , Coinfection , Anti-Bacterial Agents/adverse effects , COVID-19/complications , Clostridium Infections/complications , Clostridium Infections/diagnosis , Clostridium Infections/epidemiology , Coinfection/drug therapy , Diarrhea/drug therapy , Humans , Retrospective Studies
4.
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
5.
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
6.
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
7.
Anaerobe ; 73: 102479, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1520680

ABSTRACT

Serious concerns have been raised about a possible increase in cases of Clostridioides difficile infection (CDI) during the COVID-19 pandemic. We conducted a retrospective observational single centre study which revealed that total combined community and hospital-based quarterly rates of CDI decreased during the pandemic compared to the pre-pandemic period.


Subject(s)
COVID-19 , Clostridioides difficile , Clostridium Infections , Cross Infection , COVID-19/epidemiology , Clostridium Infections/epidemiology , Cross Infection/epidemiology , Humans , Pandemics , Prevalence , Retrospective Studies , United Kingdom/epidemiology
8.
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
9.
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
10.
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
11.
Am J Health Syst Pharm ; 78(18): 1681-1690, 2021 Sep 07.
Article in English | MEDLINE | ID: covidwho-1217813

ABSTRACT

PURPOSE: We evaluated a previously published risk model (Novant model) to identify patients at risk for healthcare facility-onset Clostridioides difficile infection (HCFO-CDI) at 2 hospitals within a large health system and compared its predictive value to that of a new model developed based on local findings. METHODS: We conducted a retrospective case-control study including adult patients admitted from July 1, 2016, to July 1, 2018. Patients with HCFO-CDI who received systemic antibiotics were included as cases and were matched 1 to 1 with controls (who received systemic antibiotics without developing HCFO-CDI). We extracted chart data on patient risk factors for CDI, including those identified in prior studies and those included in the Novant model. We applied the Novant model to our patient population to assess the model's utility and generated a local model using logistic regression-based prediction scores. A receiver operating characteristic area under the curve (ROC-AUC) score was determined for each model. RESULTS: We included 362 patients, with 161 controls and 161 cases. The Novant model had a ROC-AUC of 0.62 in our population. Our local model using risk factors identifiable at hospital admission included hospitalization within 90 days of admission (adjusted odds ratio [OR], 3.52; 95% confidence interval [CI], 2.06-6.04), hematologic malignancy (adjusted OR, 12.87; 95% CI, 3.70-44.80), and solid tumor malignancy (adjusted OR, 4.76; 95% CI, 1.27-17.80) as HCFO-CDI predictors and had a ROC-AUC score of 0.74. CONCLUSION: The Novant model evaluating risk factors identifiable at admission poorly predicted HCFO-CDI in our population, while our local model was a fair predictor. These findings highlight the need for institutions to review local risk factors to adjust modeling for their patient population.


Subject(s)
Clostridioides difficile , Clostridium Infections , Cross Infection , Adult , Case-Control Studies , Clostridioides , Clostridium Infections/diagnosis , Clostridium Infections/epidemiology , Cross Infection/diagnosis , Cross Infection/epidemiology , Delivery of Health Care , Humans , Retrospective Studies , Risk Assessment
12.
Can J Gastroenterol Hepatol ; 2021: 5556354, 2021.
Article in English | MEDLINE | ID: covidwho-1211615

ABSTRACT

The prevalence of nonalcoholic fatty liver disease (NAFLD) has increased significantly over the last few decades mirroring the increase in obesity and type II diabetes mellitus. NAFLD has become one of the most common indications for liver transplantation. The deleterious effects of NAFLD are not isolated to the liver only, for it has been recognized as a systemic disease affecting multiple organs through protracted low-grade inflammation mediated by the metabolic activity of excessive fat tissue. Extrahepatic manifestations of NAFLD such as cardiovascular disease, polycystic ovarian syndrome, chronic kidney disease, and hypothyroidism have been well described in the literature. In recent years, it has become evident that patients suffering from NAFLD might be at higher risk of developing various infections. The proposed mechanism for this association includes links through hyperglycemia, insulin resistance, alterations in innate immunity, obesity, and vitamin D deficiency. Additionally, a risk independent of these factors mediated by alterations in gut microbiota might contribute to a higher burden of infections in these individuals. In this narrative review, we synthetize current knowledge on several infections including urinary tract infection, pneumonia, Helicobacter pylori, coronavirus disease 2019, and Clostridioides difficile as they relate to NAFLD. Additionally, we explore NAFLD's association with hidradenitis suppurativa.


Subject(s)
COVID-19/epidemiology , Non-alcoholic Fatty Liver Disease/complications , Non-alcoholic Fatty Liver Disease/microbiology , Clostridioides difficile , Clostridium Infections/epidemiology , Helicobacter Infections/epidemiology , Helicobacter pylori , Humans , Pneumonia/epidemiology , Urinary Tract Infections/epidemiology
13.
Future Microbiol ; 16: 439-443, 2021 04.
Article in English | MEDLINE | ID: covidwho-1181329

ABSTRACT

The COVID-19 pandemic has changed the way we practice medicine and lead our lives. In addition to pulmonary symptoms; COVID-19 as a syndrome has multisystemic involvement including frequent gastrointestinal symptoms such as diarrhea. Due to microbiome alterations with COVID-19 and frequent antibiotic exposure, COVID-19 can be complicated by Clostridioides difficile infection. Co-infection with these two can be associated with a high risk of complications. Infection control measures in hospitals is enhanced due to the COVID-19 pandemic which in turn appears to reduce the incidence of hospital-acquired infections such as C. difficile infection. Another implication of COVID-19 and its potential transmissibility by stool is microbiome-based therapies. Potential stool donors should be screened COVID-19 symptoms and be tested for COVID-19.


Subject(s)
COVID-19 , Clostridium Infections , Coinfection , Cross Infection/prevention & control , Feces , Pandemics/prevention & control , COVID-19/epidemiology , COVID-19/transmission , Clostridioides difficile/isolation & purification , Clostridium Infections/diagnosis , Clostridium Infections/epidemiology , Clostridium Infections/therapy , Coinfection/diagnosis , Coinfection/epidemiology , Fecal Microbiota Transplantation , Feces/microbiology , Feces/virology , Humans , Infection Control , SARS-CoV-2/isolation & purification
15.
Infect Control Hosp Epidemiol ; 42(4): 406-410, 2021 04.
Article in English | MEDLINE | ID: covidwho-1087384

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has induced a reinforcement of infection control measures in the hospital setting. Here, we assess the impact of the COVID-19 pandemic on the incidence of nosocomial Clostridioides difficile infection (CDI). METHODS: We retrospectively compared the incidence density (cases per 10,000 patient days) of healthcare-facility-associated (HCFA) CDI in a tertiary-care hospital in Madrid, Spain, during the maximum incidence of COVID-19 (March 11 to May 11, 2020) with the same period of the previous year (control period). We also assessed the aggregate in-hospital antibiotic use (ie, defined daily doses [DDD] per 100 occupied bed days [BD]) and incidence density (ie, movements per 1,000 patient days) of patient mobility during both periods. RESULTS: In total, 2,337 patients with reverse transcription-polymerase chain reaction-confirmed COVID-19 were admitted to the hospital during the COVID-19 period. Also, 12 HCFA CDI cases were reported at this time (incidence density, 2.68 per 10,000 patient days), whereas 34 HCFA CDI cases were identified during the control period (incidence density, 8.54 per 10,000 patient days) (P = .000257). Antibiotic consumption was slightly higher during the COVID-19 period (89.73 DDD per 100 BD) than during the control period (79.16 DDD per 100 BD). The incidence density of patient movements was 587.61 per 1,000 patient days during the control period and was significantly lower during the COVID-19 period (300.86 per 1,000 patient days) (P < .0001). CONCLUSIONS: The observed reduction of ~70% in the incidence density of HCFA CDI in a context of no reduction in antibiotic use supports the importance of reducing nosocomial transmission by healthcare workers and asymptomatic colonized patients, reinforcing cleaning procedures and reducing patient mobility in the epidemiological control of CDI.


Subject(s)
COVID-19/complications , Clostridium Infections/etiology , Cross Infection/etiology , Aged , Anti-Bacterial Agents/therapeutic use , COVID-19/prevention & control , Clostridium Infections/epidemiology , Clostridium Infections/prevention & control , Cross Infection/epidemiology , Cross Infection/prevention & control , Humans , Incidence , Middle Aged , Retrospective Studies , Spain/epidemiology
17.
Dig Dis Sci ; 66(12): 4398-4405, 2021 12.
Article in English | MEDLINE | ID: covidwho-1042837

ABSTRACT

BACKGROUND: Gastrointestinal symptoms are common in patients with COVID-19, but prevalence of co-infection with enteric pathogens is unknown. AIMS: This study assessed the prevalence of enteric infections among hospitalized patients with COVID-19. METHODS: We evaluated 4973 hospitalized patients ≥ 18 years of age tested for COVID-19 from March 11 through April 28, 2020, at two academic hospitals. The primary exposure was a positive COVID-19 test. The primary outcome was detection of a gastrointestinal pathogen by PCR stool testing. RESULTS: Among 4973 hospitalized individuals, 311 were tested for gastrointestinal infections (204 COVID-19 positive, 107 COVID-19 negative). Patients with COVID-19 were less likely to test positive compared to patients without COVID-19 (10% vs 22%, p < 0.01). This trend was driven by lower rates of non-C.difficile infections (11% vs 22% in COVID-19 positive vs. negative, respectively, p = 0.04), but not C. difficile infection (5.1% vs. 8.2%, p = 0.33). On multivariable analysis, infection with COVID-19 remained significantly associated with lower odds of concurrent GI infection (aOR 0.49, 95% CI 0.24-0.97), again driven by reduced non-C.difficile infection. Testing for both C.difficile and non-C.difficile enteric infection decreased dramatically during the pandemic. CONCLUSIONS: Pathogens aside from C.difficile do not appear to be a significant contributor to diarrhea in COVID-19 positive patients.


Subject(s)
COVID-19/epidemiology , Clostridioides difficile/isolation & purification , Clostridium Infections/epidemiology , Coinfection , Diarrhea/epidemiology , Adolescent , Adult , Aged , COVID-19/diagnosis , Clostridium Infections/diagnosis , Clostridium Infections/microbiology , Diarrhea/diagnosis , Diarrhea/microbiology , Female , Humans , Male , Middle Aged , New York City/epidemiology , Prevalence , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Young Adult
19.
Am J Infect Control ; 49(5): 640-642, 2021 05.
Article in English | MEDLINE | ID: covidwho-813428

ABSTRACT

Clostridium difficile is the most common pathogen between health care-associated infections and its incidence has increased during the last years. lack of enough evidence about effective hygiene interventions to prevent this disease. Due to the coronavirus disease 2019 (COVID­19) pandemic, several strategies to reduce microorganism spread were adopted in hospital setting. The objective of this study was to establish whether such strategies can reduce health care associated C difficile infection (HA-CDI) incidence. We found that, during the pandemic (2020) HA-CDI incidence was significantly lower with respect to the previous years. This work demonstrates that maintaining this level of attention regarding control activities related to prevention of microorganism transmission significantly reduce HA-CDI and related expenses in terms of health costs and human lives.


Subject(s)
COVID-19/prevention & control , Clostridioides difficile/isolation & purification , Clostridium Infections/diagnosis , Cross Infection/prevention & control , Guideline Adherence , COVID-19/epidemiology , Clostridium Infections/epidemiology , Cross Infection/epidemiology , Delivery of Health Care , Humans , Incidence , Italy/epidemiology , SARS-CoV-2
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