Background/Aim: Diarrhoea that occurs as a result of the presence of Clostridium difficile (reclassified as Clostridioides difficile) is usually manifested as
a hospital infection, usually after antibiotic treatment. The study aim was to
assess the incidence, characteristics and outcomes of hospitalised patients with
healthcare – associated Clostridioides difficile infection (HA – CDI) before and
during the COVID-19 pandemic.
Methods: This retrospective cohort study included patients older than 18, who
met the HA – CDI case definition. The CDI diagnosis was made by demonstrating
toxins A and B in stool samples using an immunochromatographic assay test
and polymerase chain reaction (PCR).
Results: The incidence of HA – CDI has significantly decreased from the preCOVID-19 period to the COVID-19 period (11.04 per 10,000 vs 6.49 per 10,000,
p < 0.001). Before establishing the HA – CDI diagnosis, 41.4 % of patients used
one antibiotic, 25.9 % used two and 11.2 % were treated with three or more
antibiotics. Almost one half of the applied antibiotics were from the group that
represents high risk for the development of HA – CDI. Multivariable logistic regression analysis showed that older age (OR = 3.4; 95 % CI = 0.9-12.4; p = 0.038)
and complicated disease course (OR = 11.8; 95 % CI = 2.6-53.6; p ≤ 0.001) were
associated with a higher risk of death.
Conclusion: The incidence of HA – CDI has decreased during the observed period of the COVID-19 pandemic, however, no clear connection between the impact of the pandemic and incidence reduction was found. Due to unfavourable
outcome of the treatment of HA – CDI patients during COVID-19 pandemic, the
rational use of antibiotics is necessary
