Significant Increase in Clostridioides difficile Mortality During the COVID-19 Pandemic: A Nationwide Study

Clostridioides difficile infection (CDI) is the most common nosocomial infectious diarrhea and is associated with high morbidity and mortality. There are conflicting data on the impact of Coronavirus Disease 2019 (COVID-19) on CDI. We aimed to evaluate national patterns in CDI-associated hospitalizations before and after the pandemic.

Data from the National Inpatient Sample between January 2018 and December 2020 were analyzed. Temporal trends in admissions before and after the pandemic for CDI were analyzed using survey-adjusted Poisson regression and compared to hospitalizations for patients admitted for stroke and inflammatory bowel disease as controls. Univariable and multivariable logistic regression was used to evaluate mortality in CDI-associated admissions before and after the pandemic, adjusting for COVID-19. A bidirectional relationship was also explored, evaluating mortality in COVID-19-related admissions complicated by CDI.

Rates of CDI-related hospitalizations decreased marginally during the pandemic (incidence rate ratio 0.94 [95% confidence interval [CI]: 0.93-0.96], P < .001); however, this was a significant decrease compared to hospitalization volumes for stroke (P = .01) and inflammatory bowel disease (P = .05) during initial phase of the pandemic. Mortality during the pandemic for CDI-associated hospitalizations increased (5.1% vs 4.2%); on multivariable logistic regression, this was most significant in patients with concomitant COVID-19 (adjusted odds ratio 5.33 [95% CI: 4.39-6.48], P < .001). In patients primarily admitted for COVID-19 who concurrently had CDI, risk of mortality also increased significantly (adjusted odds ratio 1.48 [95% CI: 1.36-1.61], P < .001).

Significantly increased risks of mortality were observed in CDI-associated hospitalizations with concomitant COVID-19 and vice versa.