Health
Study suggests increased risk of hospital-acquired CDI during pandemic
A new analysis of cases at three Missouri hospitals finds evidence that the COVID-19 pandemic may have increased the risk of hospital-acquired illness. Clostridioides difficile Infection (HO-CDI).
One tertiary care hospital and two community hospitals were included in the analysis. An increased risk of HO-CDI was found only in tertiary hospitals. This report American Journal of Infection Control.
Since the start of the COVID-19 pandemic, researchers have not only wondered how patients with comorbidities were affected by COVID-19, but also how COVID-19 have sought to better understand how disease affects the risk of other types of disease in patients. In this case, researchers wanted to know if the pandemic was affecting her medically-related CDI cases. So far, the data on this question are mixed, write corresponding authors Jason P. Burnham, MD, Ph.D., of Washington University in St. Louis.
To answer their question, Burnham and colleagues used HO-CDI data from 2017 to 2020 from three hospitals. After excluding patients admitted for low-risk services and those who tested positive for his CDI within 48 hours of admission (thus unlikely to have been infected in hospital), the final The dataset included 220,444 adult patients. Of these, 16,976 admissions included at least one test. difference in C, the overall positivity rate was 4.9%, Burnham and colleagues said. Only 10 of his patients had both COVID-19 and HO-CDI.
Of the 830 positive assays, the majority (656 assays) were from tertiary care hospitals.
When researchers compared 2017 HO-CDI cases in tertiary care hospitals with 2020 HO-CDI cases in medical centers, they found an increased risk of HO-CDI, which was more pronounced among patients hospitalized with COVID-19 (odds ratio) [OR] HO-CDI of 2.19; 95% CI, 1.07-4.48) was higher than for non-COVID-19 patients (OR, 1.20; 95% CI, 0.93-1.55).
Besides years of hospitalization and comorbid COVID-19, other risk factors for HO-CDI include older age and higher scores on the Modified Acute Physiology and Chronic Health Assessment (APACHE) II assessment. Patients taking certain ‘high-risk’ antibiotics and acid blockers are also at increased risk of HO-CDI, whereas those taking other antibiotics and fluoroquinolones did not. bottom. Burnham and colleagues said these findings are largely consistent with previous studies.
The authors said there are important differences between tertiary care hospitals and the two community hospitals included in this study. Tertiary hospitals had many patients with leukemia, lymphoma, or bone marrow transplants. These differences made it impractical to combine and analyze data from all three hospitals.
Burnham et al. noted that studies were limited because of the relatively small number of HO-CDI cases and those cases early in the pandemic.
“A larger dataset may reveal differences in risk factors for HO-CDI in community hospitals,” the researchers said. “Furthermore, risk factors for hospital-acquired CDI may differ between community hospitals and tertiary care hospitals, which he did not understand because HO-CDI occurs infrequently in community hospitals.”
reference
Kwon JH, Nickel KB, Leske KA, et al. Risk factors for hospital-acquired Clostridioides difficile infection before and during the severe acute respiratory syndrome coronavirus 2 pandemic. Am J Infect Control. Published online May 30, 2023. doi:10.1016/j.ajic.2023.05.015
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