The Burden of Clostridioides Difficile Infection during the COVID-19 Pandemic: A Retrospective Case-Control Study in Italian Hospitals (CloVid)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
- Same gender
- Hospitalization in the same hospital and in the same unit
- Same date of hospital admission ±7 days
- Same age ±3 years
2.2. Data Analysis
2.3. Statistical Analysis
3. Results
3.1. CDI Incidence among COVID-19 Patients
3.2. Clinical Features of Clostridioides Difficile Infection in COVID-19 Patients
3.3. Risk Factors for the Onset of CDI in COVID-19 Patients
4. Discussion
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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CDI Patients (n: 38) | Control COVID-19 Patients (n: 114) | Fisher’s Test (Paired t Test for CCI) | Odds Ratio (95% CI) | |
---|---|---|---|---|
Female gender | 23 (60.5%) | 69 (60.5%) | ||
Age (years) | 79 (range: 53–97) | 79 (range: 51–96) | ||
Comorbidities | ||||
| 1 (2.6%) | 10 (8.7%) | p: 0.2 | |
| 32 (84.2%) | 65 (57.0%) | p: 0.009 | 3.2 (1.2–8.3) |
| 8 (21.0%) | 20 (17.5%) | p: 0.4 | |
| 7 (18.4%) | 27 (23.6%) | p: 0.3 | |
| 12 (31.5%) | 20 (17.5%) | p: 0.2 | |
| 1 (2.6%) | 3 (2.6%) | p: 0.4 | |
| 2 (5.2%) | 4 (4.2%) | p: 0.6 | |
| 16 (42.1%) | 38 (33.3%) | p: 0.4 | |
| 2 (5.2%) | 0 | p: 0.07 | |
| 10 (26.3%) | 20 (17.5%) | p: 0.3 | |
| 8 (21.0%) | 24 (21.0%) | p: 0.5 | |
| 3 (7.8%) | 1 (0.9%) | p: 0.06 | |
| 3 (7.8%) | 0 | p: 0.015 | 1.1 (1–1.2) |
| 5 (13.1%) | 2 (1.7%) | p: 0.011 | 8.4 (1.5–45) |
Mean age-adjusted CCI at admission | 6.6 | 5.6 | p: 0.03 | - |
Hospitalisation in the previous two months | 25 (65.7%) | 26 (22.8%) | p: 0.0003 | 6.1 (2.7–13.7) |
Transferred to the hospital from a LTHCF | 16 (42.1%) | 36 (31.5%) | p: 0.3 | |
Antibiotic in the previous two months | 21 (55.2%) | 21 (18.4%) | p: 0.0001 | 4.3 (2–9.5) |
Proton pump inhibitors in the previous two months | 25 (65.7%) | 42 (36.8%) | p: 0.004 | 2.9 (1.3–6.3) |
Steroids in the previous two months ° | 8 (21.0%) | 3 (2.6%) | p: 0.002 | 7.2 (2–25.7) |
COVID-19 severity | ||||
| 7 (18.4%) | 24 (21.0%) | p: 0.5 | |
| 15 (39.4%) | 32 (28.0%) | p: 0.2 | |
| 12 (31.5%) | 33 (28.9%) | p: 0.3 | |
| 3 (7.8%) | 24 (21.0%) | p: 0.05 | 0.3 (0.1–1.1) |
| 1 (2.6%) | 1 (0.8%) | p: 0.4 | |
Intensive care unit stay during the hospitalisation | 5 (13.1%) | 13 (11.4%) | p: 0.5 | |
Complications during hospitalization | ||||
| 2 (5.2%) | 4 (3.5%) | p: 0.5 | |
| 16 (42.1%) | 42 (36.8%) | p: 0.4 | |
| 1 (2.6%) | 0 | p: 0.4 | |
| 18 (47.3%) | 16 (14.0%) | p: 0.0007 | 5.9 (2.5–13.7) |
Medication for COVID-19 during the hospital stay | ||||
| 14 (36.8%) | 44 (38.5%) | p: 0.5 | |
| 26 (68.4%) | 80 (70.1%) | p: 0.4 | |
| 0 | 1 (0.8%) | p: 0.7 | |
| 3 (7.8%) | 20 (17.5%) | p: 0.1 | |
| 35 (92.1%) | 87 (76.3%) | p: 0.1 | |
| 9 (23.6%) | 42 (36.8%) | p: 0.07 | |
| 25 (65.7%) | 72 (63.1%) | p: 0.2 | |
| 32 (84.2%) | 63 (55.2%) | p: 0.001 | 4.1 (1.6–10.7) |
Patients outcome | ||||
| 19 (50%) | 74 (64.9%) | p: 0.01 | 0.4 (0.1–0.8) |
| 8 (21.0%) | 8 (7.0%) | p: 0.1 | |
| 11 (28.9%) | 25 (21.9%) | p: 0.1 | |
Total length of in-hospital stay (days) | 35 (range: 1–96) | 19.4 (range: 1–88) | p: 0.0007 |
CDI Patients (n: 38) | Control COVID-19 Patients (n: 114) | Paired t-Test (p-Value) | |
---|---|---|---|
C Reactive Protein (mg/dL) | 16.9 ± 22.2 | 17.1 ± 24.3 | 0.1 |
Ferritin (ng/dL) | 1247.0 ± 3194.7 | 572.1 ± 494.4 | 0.09 |
Fibrinogen (mg/dL) | 546.1 ± 194.8 | 464.1 ± 172.8 | 0.06 |
D-dimer (ng/mL) | 3735.3 ± 4945.0 | 2527.0 ± 3931,0 | 0.2 |
Interleukin-6 (pg/mL) | 25.5 ± 37.3 | 29.3 ± 47.8 | 0.8 |
Total white blood cells peripheral count (103 cells/µL) | 12.160 ± 9.780 | 8.149 ± 4.863 | 0.05 |
Neutrophils peripheral count (103 cells/µL) | 9.950 ± 9.626 | 6.245 ± 4.562 | 0.05 |
Blood creatinine value (mg/dL) | 2.29 ± 5.56 | 1.35 ± 1.34 | 0.1 |
Blood albumin value (g/dL) | 2.74 ± 0.54 | 3.07 ± 0.51 | 0.02 |
COVID-19 Patients with CDI (n: 38) | |
---|---|
Hospital-onset CDI | 32 (84.2%) |
Community-onset, healthcare-associated CDI | 6 (15.8%) |
First CDI episode | 36 (94.7%) |
Recurrence of CDI | 2 (5.3%) |
Diarrhea onset before the COVID-19 diagnosis | 6 (15.8%) |
Diarrhea onset after the COVID-19 diagnosis | 32 (84.2%) |
CDI severity at diagnosis | |
| 23 (60.5%) |
| 11 (28.9%) |
| 4 (10.5%) |
Administered anti-CD antimicrobial treatment | |
| 26 (68.4%) |
| 5 (13.1%) |
| 3 (7.8%) |
| 3 (7.8%) |
| 1 (2.6%) |
Surgery for complicated CDI | 0 |
Stool transplantation | 2 (5.2%) |
Follow up at 30 days from the discharge | |
| 11 (28.9%) |
| 6 (15.7%) |
Patients followed-up at 30 days from the discharge | 21 |
| 15 (71.4%) |
| 3 (14.3%) |
| 3 (14.3%) |
| 1 (4.7%) |
| 1 (4.7%) |
CDI Patients (n: 38) | Control COVID-19 Patients (n: 114) | Univariate Analysis | Multivariate Analysis | |||
---|---|---|---|---|---|---|
p-Value | Odds Ratio (95% CI) | p-Value | Odds Ratio (95% CI) | |||
Comorbidities | ||||||
| 32 (84.2%) | 65 (57.0%) | 0.009 | 3.2 (1.2–8.3) | 0.1 | |
| 3 (7.8%) | 0 | 0.015 | 1.1 (1–1.2) | 0.9 | |
Hospitalisation in the previous two months | 25 (65.7%) | 26 (22.8%) | 0.0003 | 6.1 (2.7–13.7) | 0.001 | 5.5 (2.2–13.8) |
Antibiotic in the previous two months | 21 (55.2%) | 21 (18.4%) | 0.0001 | 4.3 (2–9.5) | 0.4 | |
Proton pump inhibitors in the previous two months | 25 (65.7%) | 42 (36.8%) | 0.004 | 2.9 (1.3–6.3) | 0.07 | |
Steroids in the previous two months ° | 8 (21.0%) | 3 (2.6%) | 0.002 | 7.2 (2–25.7) | 0.008 | 8.4 (1.7–40.8) |
Medication for COVID-19 during the hospital stay | ||||||
| 32 (84.2%) | 63 (55.2%) | 0.001 | 4.1 (1.6–10.7) | 0.004 | 5.6 (1.7–18.4) |
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Granata, G.; Bartoloni, A.; Codeluppi, M.; Contadini, I.; Cristini, F.; Fantoni, M.; Ferraresi, A.; Fornabaio, C.; Grasselli, S.; Lagi, F.; et al. The Burden of Clostridioides Difficile Infection during the COVID-19 Pandemic: A Retrospective Case-Control Study in Italian Hospitals (CloVid). J. Clin. Med. 2020, 9, 3855. https://doi.org/10.3390/jcm9123855
Granata G, Bartoloni A, Codeluppi M, Contadini I, Cristini F, Fantoni M, Ferraresi A, Fornabaio C, Grasselli S, Lagi F, et al. The Burden of Clostridioides Difficile Infection during the COVID-19 Pandemic: A Retrospective Case-Control Study in Italian Hospitals (CloVid). Journal of Clinical Medicine. 2020; 9(12):3855. https://doi.org/10.3390/jcm9123855
Chicago/Turabian StyleGranata, Guido, Alessandro Bartoloni, Mauro Codeluppi, Ilaria Contadini, Francesco Cristini, Massimo Fantoni, Alice Ferraresi, Chiara Fornabaio, Sara Grasselli, Filippo Lagi, and et al. 2020. "The Burden of Clostridioides Difficile Infection during the COVID-19 Pandemic: A Retrospective Case-Control Study in Italian Hospitals (CloVid)" Journal of Clinical Medicine 9, no. 12: 3855. https://doi.org/10.3390/jcm9123855