Abstract
Broad-spectrum antibiotics administered to patients with severe COVID-19 pneumonia pose a risk of infection caused by Clostridioides difficile. This risk is reduced mainly by strict hygiene measures and early de-escalation of antibiotic therapy. Recently, oral vancomycin prophylaxis (OVP) has also been discussed. This retrospective study aimed to assess the prevalence of C. difficile in critical COVID-19 patients staying in an intensive care unit of a tertiary hospital department of anesthesiology, resuscitation, and intensive care from November 2020 to May 2021 and the rates of vancomycin-resistant enterococci (VRE) after the introduction of OVP and to compare the data with those from controls in the pre-pandemic period (November 2018 to May 2019). During the COVID-19 pandemic, there was a significant increase in toxigenic C. difficile rates to 12.4% of patients, as compared with 1.6% in controls. The peak rates were noted in February 2021 (25% of patients), immediately followed by initiation of OVP, changes to hygiene precautions, and more rapid de-escalation of antibiotic therapy. Subsequently, toxigenic C. difficile detection rates started to fall. There was a nonsignificant increase in VRE detected in non-gastrointestinal tract samples to 8.9% in the COVID-19 group, as compared to 5.3% in the control group. Molecular analysis confirmed mainly clonal spread of VRE.
Highlights
For coronavirus disease 2019 (COVID-19) patients with critical pneumonia requiring high-flow oxygen therapy (HFOT), mechanical ventilation, or even extracorporeal membrane oxygenation (ECMO), broad-spectrum antibiotic therapy is recommended by theWorld Health Organization (WHO) [1]
Administration of broad-spectrum antibiotics, often necessary in critical COVID-19 patients suspected of bacterial superinfection, poses a high risk for Clostridioides difficile infection (CDI), with some antibiotic classes being more strongly associated with
During the COVID-19 pandemic, the number of patients staying in KARIM intensive care unit (ICU) was nearly double (196.8%) the average
Summary
For coronavirus disease 2019 (COVID-19) patients with critical pneumonia requiring high-flow oxygen therapy (HFOT), mechanical ventilation, or even extracorporeal membrane oxygenation (ECMO), broad-spectrum antibiotic therapy is recommended by theWorld Health Organization (WHO) [1]. For coronavirus disease 2019 (COVID-19) patients with critical pneumonia requiring high-flow oxygen therapy (HFOT), mechanical ventilation, or even extracorporeal membrane oxygenation (ECMO), broad-spectrum antibiotic therapy is recommended by the. The role of antibiotic therapy in these most severe patients remains unclear. Studies published so far suggest that the incidence of secondary bacterial infections is lower than originally expected based on previous respiratory disease epidemics (severe acute respiratory syndrome, Middle East respiratory syndrome, H1N1 influenza) [2,3]. Questions persist as to whether antibacterial therapy should be immediately initiated in COVID-19 inpatients requiring invasive oxygen therapy, mechanical ventilation, or ECMO. Administration of broad-spectrum antibiotics, often necessary in critical COVID-19 patients suspected of bacterial superinfection, poses a high risk for Clostridioides difficile infection (CDI), with some antibiotic classes being more strongly associated with. Several reports have already been published concerning CDI occurrence during the COVID-19 pandemic with contradictory findings: a decrease or stable number of cases [5,6,7,8,9] as opposed to a minor [10] or significant [11] increase in the incidence of CDI
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
