S143 Prevalence of Clostridium difficile During the COVID-19 Pandemic

Abstract

Introduction: Clostridium difficile continues to affect patients and can represents a wide spectrum of disease including mild diarrhea to toxic megacolon and risk of death. Severe acute respiratory syndrome coronavirus (SARS-CoV-2), known as COVID-19, has created a healthcare crisis and presents with a wide spectrum of clinical manifestations: fever, dry cough, pneumonia, pulmonary edema and acute respiratory distress syndrome resulting in multiple organ failure. Along with this, a less prevalent but increasing symptom is diarrhea. The etiology of gastrointestinal symptoms associated with COVID-19 infection is not well understood, though the ACE2 receptor may play a part in the pathogenesis of the disease. This study investigated the prevalence of C. difficile infection with the increased usage of personal protective equipment (PPE), contact precautions, and emphasis of hand washing during the COVID-19 pandemic. Methods: A descriptive, cross-sectional study was conducted at Franciscan Health Olympia Fields, Illinois from 2/2020 to 5/2020. Data during this study period was compared to data collected for the same time period in 2019. Inclusion criteria included all inpatient admissions greater than the age of 18 who were tested for C. difficile infection via PCR. Additionally, patients selected during the 2020 time period were also positive for COVID 19 via PCR. Patient data was extracted from EPIC EMR software and a chi-square test was utilized for statistical comparison. Results: A total of 314 and 312 patients respectively were identified. A total of 34 (10.8%) patients in 2020 and 32 (10.3%) patients in 2019 were positive for C. difficile by testing positive for C. difficile toxin B by PCR. The total number of patients in 2020 who were positive for both C. difficile and COVID-19 was 6. A Chi-Square test found no significant difference in the number of C. difficile infections in 2020 versus 2019. Increased use of PPE and increased emphasis on hand washing during the 2020 COVID-19 pandemic had no significant difference in the number of C. difficile infections compared to 2019, X2 (1, N = 669) = 0.0608, p = .805244. Conclusion: The increased use of PPE, contact precautions and emphasis on hand washing did not have an effect on the incidence of hospital acquired C. difficile. These unexpected outcomes are likely attributed to the combined results of an increase in COVID-19 precautions along with a potential increase in the usage of empiric antibiotics during the initial onset of the COVID-19 pandemic.