Jessica R. Allegretti, MD, MPH1, Cheikh Njie, MD1, Emma McClure1, Walker D. Redd, MD1, Danny Wong, MD1, Joyce C. Zhou, BA2, Ahmad Najdat Bazarbashi, MD3, Thomas R. McCarty, MD1, Kelly E. Hathorn, MD1, Lin Shen, MD1, Kunal Jajoo, MD1, Walter W. Chan, MD, MPH1; 1Brigham & Women's Hospital, Boston, MA; 2Harvard Medical School, Boston, MA; 3Brigham & Women's Hospital, Somerville, MA
Introduction: Gastrointestinal manifestations including diarrhea are prevalent among COVID-19 patients. Given the frequent use of broad-spectrum antibiotics, COVID-19 patients are also at substantial risk for hospital-acquired diarrheal illnesses. We aimed to evaluate the prevalence and outcomes of Clostridioides difficile infection (CDI) among hospitalized patients with COVID-19. Methods: This was a retrospective cohort study of patients hospitalized with laboratory confirmed COVID-19 across 9 hospitals in Massachusetts in 3/11/2020-4/2/2020. All patients underwent stool testing for CDI with glutamate dehydrogenase (GDH) and ELISA immunoassay (EIA) for toxin. Inconclusive GDH/EIA with high clinical suspicion were confirmed with polymerase chain reaction (PCR). Positive CDI rate in COVID-19 patients was compared with local historical inpatient CDI testing data from 2019. Outcomes and mortality were also compared amongst COVID-19 patients with and without CDI. Results: Of the 390 hospitalized patients with COVID-19, 97 (24.9%) were tested for CDI and included in the study. All patients received ≥2 antibiotics (median=4, IQR 2-5.5). Compared to historical controls, COVID-19 patients did not have higher overall CDI positive rate (5.2% [n=5] vs 9.8% [n=280]; p=0.16). Specifically, GDH/EIA positive rates were similar between both groups (5.2% vs 5.3%). There were no statistically significant differences in median antibiotic use, PPI use, laboratory data or need for ICU care between CDI vs non-CDI patients. However, all-cause mortality was significantly higher among CDI patients (80% vs 12.2%; p< 0.0001) Table 1. Discussion: The prevalence of CDI was not higher among COVID-19 patients despite widespread use of broad-spectrum antibiotics. With strict isolation of COVID-19 patients in most hospitals, together with aggressive hand washing and donning/doffing protocols, it is possible that such rigorous measures resulted in the unintended benefit of reducing nosocomial CDI. However, albeit a limited sample size, development of CDI was associated with significantly worse outcomes and higher mortality. As such, early CDI testing should be implemented among patients with COVID-19 to ensure prompt diagnosis and management.
Table 1: (A) Clostridioides difficile infection stool testing of COVID-19 patients compared to all inpatient CDI tests in 2019. (B) Hospitalization course and outcomes of COVID-19 patients with and without CDI. * Stool PCR only performed with GDH/EIA indeterminant samples.
Disclosures: Jessica Allegretti: Finch Therapeutics – Consultant. Merck – Grant/Research Support. Cheikh Njie indicated no relevant financial relationships. Emma McClure indicated no relevant financial relationships. Walker Redd indicated no relevant financial relationships. Danny Wong indicated no relevant financial relationships. Joyce Zhou indicated no relevant financial relationships. Ahmad Najdat Bazarbashi indicated no relevant financial relationships. Thomas McCarty indicated no relevant financial relationships. Kelly Hathorn indicated no relevant financial relationships. Lin Shen indicated no relevant financial relationships. Kunal Jajoo indicated no relevant financial relationships. Walter Chan indicated no relevant financial relationships.