Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2021; 9(33): 10180-10188
Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10180
Did the severe acute respiratory syndrome-coronavirus 2 pandemic cause an endemic Clostridium difficile infection?
Camelia Cojocariu, Irina Girleanu, Anca Trifan, Andrei Olteanu, Cristina Maria Muzica, Laura Huiban, Stefan Chiriac, Ana Maria Singeap, Tudor Cuciureanu, Catalin Sfarti, Carol Stanciu
Camelia Cojocariu, Irina Girleanu, Anca Trifan, Andrei Olteanu, Cristina Maria Muzica, Laura Huiban, Stefan Chiriac, Ana Maria Singeap, Tudor Cuciureanu, Catalin Sfarti, Carol Stanciu, Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” University Hospital, Institute of Gastroenterology and Hepatology, Iasi 700115, Romania
Author contributions: All authors participated in discussion, writing and/or editing of the manuscript, have read and approved the final version submitted and accept responsibility for its content; Trifan A, Cojocariu C and Stanciu C participated in the design of the review, data collection, analysis and interpretation, manuscript preparation and revision, and approved the final version of the final draft submitted; Huiban L, Olteanu A, Sfarti C, Muzica C, Chiriac S, Cuciureanu T, Girleanu I and Singeap AM performed the acquisition of data and contributed to the drafting of the manuscript; Sfarti C, Muzica C, Huiban L and Girleanu I contributed to the analysis and interpretation of data.
Institutional review board statement: The Institutional Review Board of St Spiridon Hospital, Iasi provided approval for this study.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anca Trifan, FRCP, MD, Teacher, Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” University Hospital, Institute of Gastroenterology and Hepatology, Str. Universității no 16, Iasi 700115, Romania. ancatrifan@yahoo.com
Received: April 28, 2021
Peer-review started: April 28, 2021
First decision: June 23, 2021
Revised: July 23, 2021
Accepted: October 14, 2021
Article in press: October 14, 2021
Published online: November 26, 2021
Processing time: 207 Days and 14.2 Hours
ARTICLE HIGHLIGHTS
Research background

The coronavirus disease 2019 (COVID-19) pandemic profoundly altered medical practice and has brought forth multiple challenges for gastroenterologists in handling of patients with digestive diseases, due to the many digestive and hepatic manifestations of COVID-19. Frequently, residual/post-infection issues can alter the course of patients with digestive disorders (especially patients with inflammatory bowel disease, advanced liver disease, etc.). Clostridium difficile infection (CDI) was also a challenge for gastroenterology during the COVID-19 pandemic.

Research motivation

Many patients diagnosed with COVID-19 have numerous risk factors for CDI, including broad-spectrum antibiotic treatment, hospitalization, elderly age, multiple comorbidities, and immunocompromised status.

Research objectives

The aim of this study was to analyze the factors that influenced CDI development after COVID-19.

Research methods

Between March 2020 to December 2020, we performed a prospective observational study including 447 patients diagnosed with CDI who had been admitted to our tertiary referral university hospital. The diagnosis of CDI was based on the presence of diarrhea (≥ 3 watery stools within 24 h) associated with C. difficile toxin A or B.

Research results

Most of the patients in our study were male (54.3%), and showed a mean age of 59.7 ± 10.8 years. Of all the patients included in the study, 76 (17.0%) had a history of COVID-19. The patients with a history of COVID-19 were more likely to be elderly, have a history of alcohol consumption and have previous hospitalizations and antibiotic treatments than the patients without a history of COVID-19. The patients with a history of COVID-19 also needed higher doses of vancomycin and were prone to recurrent disease. Age over 60 years, residence in an urban area, previous antibiotic treatment, and previous and current alcohol consumption were identified as risk factors for CDI development in patients with COVID-19.

Research conclusions

Hospitalizations, antibiotic use and alcohol consumption represent risk factors for CDI development in patients over 60-years-old from an urban area with a history of COVID-19. These patients were at higher risk of recurrence and needed higher doses of vancomycin for CDI treatment.

Research perspectives

Our study highlights the importance of judicious use of antibiotics and recognizing the patients at risk for developing CDI. Future research should focus on the management of patients with CDI after or during COVID-19 in order to improve the prognosis in these patients.