Clostridioides difficile infection in coronavirus disease 2019: an underestimated problem?

INTRODUCTION: The use of antibiotics and the possibility of microbiota disruption during the COVID-19 pandemic have raised questions about the incidence of Clostridioides difficile infection (CDI). OBJECTIVES: To assess the frequency and risk factors for CDI in coronavirus disease 2019 (COVID-19) patients. PATIENTS AND METHODS: A retrospective, single-center assessment of the frequency and risk factors for CDI in patients with COVID-19 and in the pre-pandemic era. The analysis included 441 patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and 2,961 patients hospitalized before the pandemic. RESULTS: There was a significant increase in the incidence of CDI during the COVID-19 pandemic compared to the pre-pandemic period: 10.9% vs 2.6%, p <0.0001. Risk factors for CDI in COVID-19 patients included: age, length of hospital stay, occurrence of diarrhea during hospitalization, antibiotics other than azithromycin, coexistence of nervous system disease, and chronic kidney disease - all had weak association with CDI development. Multivariable logistic regression model indicated the presence of other unmeasured variables which had an impact on CDI incidence rate. CONCLUSIONS: We have observed a significantly higher incidence of CDI in patients with COVID-19. Antibiotic treatment was an important risk factor, although the effect was weak. Other drugs used during the pandemic did not have an impact. Possible causes may include fecal microbiota disruption by SARS-CoV-2 infection, but more studies are needed to prove this hypothesis.