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Antibiotic Usage and Healthcare-Associated Clostridioides difficile in Patients with and Without COVID-19: A Tertiary
Darko Zdravkovic1,2, Ljiljana Markovic-Denic1,3, Vladimir Nikolic3
1University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia.
Insights
COVID-19 patients with healthcare-associated Clostridioides difficile infection (HA-CDI) received more broad-spectrum antibiotics, including cephalosporins and fluoroquinolones. This suggests a link between specific antibiotic use and HA-CDI risk in COVID-19 patients.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- The association between COVID-19 and healthcare-associated Clostridioides difficile infection (HA-CDI) remains debated.
- Understanding antibiotic patterns in HA-CDI patients with and without COVID-19 is crucial for infection control.
Purpose of the Study:
- To investigate the specific antibiotics associated with HA-CDI in patients with and without concurrent COVID-19 infection.
- To identify risk factors for HA-CDI in the context of COVID-19.
Main Methods:
- Prospective cohort study conducted from January 2019 to December 2021.
- Inclusion of patients with their first HA-CDI episode, comparing those with and without COVID-19.
- Collection of demographic, clinical, and antibiotic usage data, including daily defined doses (DDD).
Main Results:
- Out of 547 HA-CDI cases, 341 (62.3%) were co-infected with COVID-19.
- COVID-19 patients with HA-CDI were younger, had fewer comorbidities, and received two or more antibiotics more frequently.
- Third- and fourth-generation cephalosporins, fluoroquinolones, and macrolides were significantly more common in COVID-19 patients; ceftriaxone showed higher median DDD.
Conclusions:
- Patients with HA-CDI and COVID-19 frequently received multiple antibiotics prior to infection.
- Specific antibiotic classes, including third- and fourth-generation cephalosporins and fluoroquinolones, are independently associated with increased HA-CDI risk in COVID-19 patients.
Abstract:
Background/Objectives: Data about the relationship between COVID-19 and healthcare-associated Clostridioides difficile infection (HA-CDI) occurrence are still controversial. This study examines antibiotics associated with CDI in patients with and without COVID-19 infection. Methods: A prospective cohort study was conducted at the University Clinical Center Belgrade, Serbia, from January 2019 to December 2021. Patients with the first episode of HA-CDI without and with COVID-19 were included. Results of bacteriology analyses, demographic and clinical data, and data on antibiotic usage and daily defined doses (DDD) were collected by the hospital Infection Control Team. Results: Out of 547 HA-CDI cases, 341 (62.3%) had COVID-19 infection. HA-CDI patients with COVID-19 were significantly younger (p = 0.017) with fewer comorbidities (<0.001). Two or more antibiotics in therapy were more frequently used by those patients (p = 0.03). COVID-19 patients were treated significantly more by third- and fourth-generation cephalosporins, fluoroquinolones (p < 0.001) and macrolides (p = 0.01). Ceftriaxone had a higher median DDD in COVID-19 patients (6.00, range 1.00-20.00) compared to non-COVID-19 patients (4.00, range 1.00-14.00), (p = 0.007). Conversely, meropenem showed a lower median DDD in COVID-19 patients. Multivariate analysis identified the use of fourth-generation cephalosporins and fluoroquinolones as independent risk factors for HA-CDI in COVID-19 patients. Conclusions: Patients with HA-CDI and COVID-19 more frequently received two or more antibiotics before the onset of HAI-CDI. The third and fourth generations of cephalosporins, fluoroquinolones and macrolides were administered significantly more often in these patients. More frequent administration of ceftriaxone was observed, but the lower DDD associated with meropenem needed additional analysis.
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