Influence of COVID-19 on Clinical Outcomes of Clostridioides difficile Infection

Backgroud/Objectives:Clostridioides difficile infection (CDI) remains a major problem for healthcare facilities. The COVID-19 pandemic was associated with increased hospitalizations, frequent antibiotic use, and changes in infection prevention and control regulations, which may have influenced the epidemiological and clinical characteristics of CDI. The aim of this study was to evaluate whether a history of COVID-19 was associated with clinical characteristics, treatment exposure, recurrence, ribotype distribution, and mortality in patients with CDI. Methods: This retrospective study included patients diagnosed with CDI during the period 2020-2022 at the Louis Pasteur University Hospital in Košice, Slovakia. We analyzed 324 patients, of whom 172 (53.1%) had no history of COVID-19 and 144 (44.4%) had previous or concurrent COVID-19, defined as documented infection within three months before or at the time of CDI diagnosis. Eight patients (2.5%) developed COVID-19 after CDI diagnosis and were excluded from the comparative analyses. Results: Patients with previous or concurrent COVID-19 had higher exposure to PPIs (88.2% vs. 73.3%; p = 0.0009), corticosteroids (70.1% vs. 26.2%; p < 0.0001), cephalosporins (72.9% vs. 61.6%; p = 0.034) and macrolides (37.5% vs. 20.3%; p = 0.0007). Overall antibiotic exposure was high (93.8%) and did not differ significantly between patients with previous or concurrent COVID-19 and those without COVID-19 (93.8% vs. 94.2%; p = 0.871). Previous or concurrent COVID-19 was not associated with increased 90-day mortality after CDI (42.4% vs. 43.6%; p = 0.824). Conclusions: Our findings suggest that a history of COVID-19 was associated with the risk factor profile, recurrence rate and the molecular epidemiology of CDI, rather than with a more severe clinical course or worse prognosis.