Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Effect of the COVID-19 Pandemic on Rates and Epidemiology of Clostridioides difficile Infection in One VA Hospital

Lorinda M. Wright
* ORCID logo ,
Andrew M. Skinner
,
Adam Cheknis
,
Conor McBurney
,
Ling Ge
,
Susan Pacheco
,
David Leehey
,
Dale N. Gerding
,
And Stuart Johnson
Version 1 : Received: 7 June 2023 / Approved: 8 June 2023 / Online: 8 June 2023 (10:55:48 CEST)

A peer-reviewed article of this Preprint also exists.

Wright, L.M.; Skinner, A.M.; Cheknis, A.; McBurney, C.; Ge, L.; Pacheco, S.M.; Leehey, D.; Gerding, D.N.; Johnson, S. Effect of the COVID-19 Pandemic on Rates and Epidemiology of Clostridioides difficile Infection in One VA Hospital. Antibiotics 2023, 12, 1159. Wright, L.M.; Skinner, A.M.; Cheknis, A.; McBurney, C.; Ge, L.; Pacheco, S.M.; Leehey, D.; Gerding, D.N.; Johnson, S. Effect of the COVID-19 Pandemic on Rates and Epidemiology of Clostridioides difficile Infection in One VA Hospital. Antibiotics 2023, 12, 1159.

Abstract

The COVID-19 pandemic was associated with increases in some healthcare-associated infections. We investigated the impact of the pandemic on 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 pre-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 10/2019 – 3/2022. CDI case numbers declined 43.2% in 2020 – 2021 compared to the annual mean over the previous 5 years. Stool test positivity rate was also lower during the COVID-19 pandemic (14.3% vs. 17.2%; P = 0.013). Although inpatient volume declined, rates of CDI among inpatients were reduced by 34.2% in 2020 – 2021. 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 March 8, 2020, through June 30, 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 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 initial waves of the COVID-19 pandemic. In contrast, REA BI (Ribotype 027), a virulent, previously epidemic CD strain and frequently associated with hospital transmission and outbreaks, reappeared as a prevalent strain during the first wave of the pandemic.

Keywords

Clostridioides difficile; COVID-19; SARS-CoV-2

Subject

Biology and Life Sciences, Life Sciences

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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