Clostridioides difficile Infections during the COVID-19 Pandemic

Objective To compare rates of prepandemic Clostridioides difficile infection (CDI) during the COVID-19 pandemic and the rates of antibacterial use prepandemic and during the COVID-19 pandemic. Design This was a retrospective data review. Setting This study was performed at an academic medical center. Patients Patients were all adult patients admitted to the hospital between April 1, 2019, and December 31, 2019, who were tested for CDI and admitted in the same time frame in 2020, and who were tested for CDI were included in the study. Methods Retrospective data analysis was conducted across 5 hospitals from April 1 to December 31, 2019 (prepandemic), and on the same dates in 2020 during the pandemic. The standardized infection ratio (SIR) for hospital-acquired CDI (HA-CDI) was calculated for both groups. The mean and normal distributions were calculated for all values in both the groups. The 2 groups were compared using unpaired t tests for continuous variables and χ2 tests for discrete variables. Results Thirty-six patients were diagnosed with HA-CDI before the pandemic (2019), and 45 patients during the pandemic (2020). The 2019 HA-CDI SIRs were 0.47 in 2019 and 0.56 in 2020. Days of therapy per 1000 patient-days of antibiotics increased from 337.1 to 364.6 (P = 0.0057). Analysis of 153 inpatients with diarrhea revealed no positive association between COVID and CDI. Conclusion During the COVID-19 pandemic, empiric broad-spectrum antibacterial use increased in our system, as did HA-CDI SIR compared with the national standards. We did not observe a positive correlation between COVID-19 and CDI.