Infectious Disease

No substantial changes in C. difficile trends early in pandemic

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The authors report no relevant financial disclosures.

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Despite the changes and disruptions to care caused by COVID-19, researchers found that there were no significant changes in the incidence of Clostridioides difficile during the first year of the pandemic.

“C difficile is the most common pathogen causing health care-associated infections in the United States,” James baGgs, PhD, an epidemiologist in the CDC’s Division of Healthcare Quality Promotion, told Healio.

Clostridioides difficile

There were no substantial changes in the incidence of community-onset and hospital-onset CDI early in the pandemic. Source: Adobe Stock.

James Baggs

The pandemic “caused substantial changes to health care delivery and antibiotic prescribing beginning in March 2020,” Baggs said. “Changes in both inpatient and outpatient antibiotic use during 2020 have been reported, which can impact C. difficile infection (CDI) rates.”

To assess the impact of the pandemic on CDI rates, Baggs and colleagues evaluated patient data and trends in hospital incidence from 2019 through 2020 among a cohort of 775 US hospitals.

According to the study, they estimated and compared rates of community-onset CDI (CO-CDI) per 10,000 discharges, hospital-onset CDI (HO-CDI) per 10,000 patient days and C. difficile testing rates per 10,000 discharges.

Overall, they found that CO-CDI rates decreased from 20 to 15.8 per 10,000 discharges between 2019 and 2020 (P < .0001), whereas HO-CDI rates did not change. They also observed decreasing monthly trends in CO-CDI (1% per month; P = .0036) and HO-CDI incidence (1% per month; P < .0001) during the baseline period, before the pandemic was declared. After that, the researchers found that there was no change in monthly trends for CO-CDI incidence, HO-CDI incidence or percent positivity after March 2020.

Baggs said that, given the changing nature of health care in 2020 and 2021, it would be difficult to predict if these trends would continue into 2021, although he said that CDC will monitor them.

“Continued attention to antibiotic stewardship and infection control practices are critical to reduce the significant morbidity and mortality associated with C. difficile infection,” Sujan C Reddy, MD, MPH, a medical officer in the CDC’s Division of Healthcare Quality Promotion, told Healio.

Sujan Reddy

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