S0149 Clostridioides difficile Infection Trends in a Health System During COVID-19 Pandemic

Abstract

INTRODUCTION: Clostridioides difficile Infection (CDI) is a common nosocomial infection with significant disease burden. From 2011 to 2017, a decline in nosocomial spread with stable community spread of CDI was observed. With the current coronavirus disease 2019 (Covid-19) pandemic, many healthcare systems noted dramatic shifts in hospital census along with changes in infection control. We conducted a retrospective single-center study to determine whether changes in hospital census and infection control during Covid-19 affected rates of CDI. METHODS: Monthly inpatient admissions and outpatient visits from 11/1/2019 through 5/31/2020 were obtained from University of Virginia health analytics database. We included all patients who had Clostridioides difficile PCR, noting the PCR result and the setting from which it was obtained. Rates of CDI during preCovid-19 (11/1/2019–2/31/2020) and postCovid-19 (3/1–5/31/2020) periods were compared. A sample of primary care providers (PCPs) were surveyed regarding empiric CDI prescribing habits to determine if empiric treatment was offered in lieu of testing during COVID-19. RESULTS: Our institution had a decline in hospital census in the postCovid-19 period (Tables 1 and 2). In the inpatient setting, the number of positive CDI tests decreased postCovid-19 (mean = 10) compared to preCovid-19 (mean = 19) (P = 0.007) (Figure 1). The proportion of positive CDI tests over monthly admissions decreased in the postCovid-19 period (P = 0.04). After controlling for age and gender, logistic regression analysis showed that the odds of testing positive for CDI decreased postCovid-19 (OR = 0.62, CI = 0.39–0.98). In the outpatient setting, the number of positive CDI tests per month was unchanged preCovid-19 (mean = 8.25) compared to postCovid-19 (mean = 7.67) (P = 0.83). A physician survey (n = 13) showed that 1 out of 13 PCPs empirically prescribed antibiotics for CDI during Covid-19. CONCLUSION: There was a significant decrease in number and proportion of inpatient CDI during Covid-19 while outpatient CDI rates remained stable. The majority of surveyed PCPs did not prescribe empiric treatment for CDI. Reasons for inpatient CDI downtrend may include decrease in elective procedures/admissions that pose risk for CDI or heightened awareness of infection control best-practices due to Covid-19. Further research is necessary to evaluate CDI trends as hospital census fluctuates and to assess outcomes of Covid19 infection control policy changes on CDI and other healthcare infections.Table 1.: Inpatient Summary DataTable 2.: Outpatient Summary DataFigure 1.: CDI Testing Results by Month.