Healthcare-associated Clostridioides difficile infection during the COVID-19 pandemic in a tertiary care hospital in Romania
Healthcare-associated Clostridioides difficile infection during the COVID-19 pandemic in a tertiary care hospital in Romania
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DOI：
10.2478/rjim-2021-0020
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发表时间：
2021-12-01
影响因子：
1.9
通讯作者：
Hristea, Adriana
中科院分区：
文献类型：
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作者：
Manea, Eliza;Jipa, Raluca;Hristea, Adriana
导论.关于COVID-19患者中医疗保健相关艰难梭菌感染（HA-CDI）的信息有限。我们旨在评估在COVID-19大流行期间和之前获得的HA-CDI的特征。我们在一家三级护理医院进行了一项回顾性研究，自2020年3月以来，该医院仅收治COVID-19患者。我们比较了2020年3月至2021年2月住院的HA-CDI成人患者与2017- 2018年同期住院的患者。我们发现2020-2021年（COVID-19组）有51例，发病率为5.6/1000成人出院，2017-2018年（COVID-19前组）有99例，发病率为6.1/1000成人出院（p=0.6）。与COVID-19前组相比，COVID-19组的患者年龄更大（中位年龄66岁vs 62岁），合并症发生率相似，但心血管疾病发生率较高（62.7% vs 42.4%）和较少的免疫抑制（21.6%vs55.6%），质子泵抑制剂使用率较高（94.1%对32.3%），以及更长的住院时间（中位数19天对14天）。（85.9%）为COVID-19前组患者，（86.3%）COVID-19组患者接受了抗菌治疗-主要是头孢菌素类（34.1%）、喹诺酮类（22.3%）和糖肽类（21.3%）。COVID-19前组主要为头孢菌素类和大环内酯类（各占63.6%）。我们在COVID-19前组中发现了4例HA-CDI相关死亡，而在COVID-19组中没有发现。COVID-19组的HA-CDI发生率与2017-2018年同期相比没有变化。抗生素使用是HA-CDI的最重要相关因素。我们发现，尽管缺乏针对COVID-19的经验性抗菌建议，但广谱抗生素的使用率很高。
Introduction. Information on healthcare-associated C.difficile infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic.Methods. We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017-2018.Results. We found 51 cases during 2020-2021 (COVID-19 group), incidence 5.6/1000 adult discharge and 99 cases during 2017-2018 (pre-COVID-19 group), incidence 6.1/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days).Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment - mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group.Conclusions. The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017-2018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19.