Study Suggests Hospital-Onset CDI Risk Increased During Pandemic

A new analysis of cases at 3 Missouri hospitals found evidence suggesting that the COVID-19 pandemic may have heightened the risk of hospital-onset Clostridioides difficile infection (HO-CDI).

The analysis included one tertiary-care hospital and 2 community hospitals. An increased risk of HO-CDI was found only at the tertiary hospital. The report was published in the American Journal of Infection Control.

Since the start of the COVID-19 pandemic, investigators have sought to better understand how patients with comorbidities were impacted by COVID-19, but also how COVID-19 affected patients’ risks of other types of illnesses. In this case, investigators wanted to know whether the pandemic had an effect on healthcare-associated cases of CDI. So far, the data on the question have been mixed, wrote corresponding author Jason P. Burnham, MD, of Washington University, in St. Louis, and colleagues.

To answer their question, Burnham and colleagues used HO-CDI data from 2017-2020 from the 3 hospitals. After excluding patients admitted to the hospital for low-risk services and those who tested positive for CDI within 48 hours of admission (and thus were unlikely to have become infected at the hospital), the final data set included 220,444 adult patients. Of those, 16,976 admissions included at least one test for C diff, and the overall positivity rate was 4.9%, Burnham and colleagues said. Only 10 patients had both COVID-19 and HO-CDI.

Of the 830 positive assays, the large majority (656 assays) were from the tertiary-care hospital.

When investigators compared 2017 cases of HO-CDI at the tertiary-care hospital to 2020 cases at the medical center, they found an increased risk of HO-CDI, though it was more pronounced among patients who were admitted with COVID-19 (odds ratio [OR] of HO-CDI 2.19; 95% CI, 1.07-4.48) than for patients without COVID-19 (OR, 1.20; 95% CI, 0.93-1.55).

Aside from year of admission and co-morbid COVID-19, other risk factors for HO-CDI included older age and higher scores on the modified Acute Physiology and Chronic Health Evaluation (APACHE) II assessment. Patients taking certain “high-risk” antibiotics and acid-blocking agents also had a higher risk of HO-CDI, but patients taking other antibiotics or fluoroquinolones did not have an increased risk. Burnham and colleagues said those findings were largely in line with previous research.

The authors said there were important differences between the tertiary-care hospital and the 2 community hospitals included in the study. The tertiary hospital had more patients with leukemia or lymphoma, or who underwent a bone-marrow transplant. Due to these differences, it was not feasible to combine the data from all 3 hospitals for analysis.

Burnham and colleagues noted that their study is limited because it had a relatively small number of HO-CDI cases and those cases were from early in the pandemic.

“It is possible a larger dataset might find differences in risk factors for HO-CDI at the community hospitals,” they said. “In addition, it is possible that risk factors for hospital-onset CDI are different between community and tertiary-care hospitals, something we were unable to capture due to infrequent HO-CDI at the community hospitals.”

Reference

Kwon JH, Nickel KB, Reske KA, et al. Risk factors for hospital-onset Clostridioides difficile infections before and during the severe acute respiratory syndrome coronavirus 2 pandemic. Am J Infect Control. Published online May 30, 2023. doi:10.1016/j.ajic.2023.05.015