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Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 78-79

Clostridioides difficile Infection in Patients with COVID-19

Department of Gastroenterology, Arihant Hospital and Research Centre, Indore, Madhya Pradesh, India

Date of Submission16-Dec-2021
Date of Decision10-Feb-2022
Date of Acceptance12-Feb-2022
Date of Web Publication23-Mar-2022

Correspondence Address:
Mayank Jain
Arihant Hospital and Research Centre, 283-A Gumasta Nagar, Indore - 452 009, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ghep.ghep_48_21

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How to cite this article:
Jain M. Clostridioides difficile Infection in Patients with COVID-19. Gastroenterol Hepatol Endosc Pract 2022;2:78-9

How to cite this URL:
Jain M. Clostridioides difficile Infection in Patients with COVID-19. Gastroenterol Hepatol Endosc Pract [serial online] 2022 [cited 2022 May 24];2:78-9. Available from: http://www.ghepjournal.com/text.asp?2022/2/2/78/340395

Frail individuals with long-standing medical diseases are vulnerable to coronavirus 19 (COVID-19) infection. Many of these patients require hospitalization, and the risk of bacterial or fungal infections in such patients is considerable.[1],[2] The use of broad-spectrum antibiotics in these patients may be associated with subsequent increase in Clostridioides difficile infection (CDI).[3] C. difficile is a multi-resistant pathogen and is the leading cause of diarrhea in health-care settings.[4]

Over the period of the last 4 months (January 2021–April 2021), the author encountered eight cases of CDI in patients who underwent treatment for COVID-19. In the previous 2 years (2019–2020), only one case of documented CDI was noted at our center. As noted from [Table 1], all patients were above 45 years of age and predominantly females. All patients had one or more comorbid states. All patients had severe COVID-19 infection and required prolonged hospital stay. Broad-spectrum antimicrobials, steroids, proton-pump inhibitors, and remdesivir were used in these patients. Six patients presented within 1 month of discharge from COVID care facility, while two were diagnosed during hospital stay. The symptoms of CDI included profuse diarrhea (8%–100%), abdominal distention (2%–25%), anorexia (2%–25%), and nausea (2%–25%). Diagnosis was confirmed by stool test for C. difficile toxin assay in all cases and sigmoidoscopy showing pseudomembranes in six cases. One case had toxic megacolon and another case was on ventilation with inotropic support. All patients were started on antibiotics – metronidazole and vancomycin. Six cases who presented post discharge improved with treatment and were doing well on follow-up at 1 month. Two cases – one with toxic megacolon and the other with multi-organ failure – succumbed to their illness.
Table 1: Characteristics of study cohort

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The present data show that there is a likelihood of increase in CDI, especially among frail elderly patients during the current COVID-19 pandemic. It is of paramount importance to screen all COVID-19 convalescents, particularly those that had gastrointestinal manifestations, for CDI. Two studies from the United States have highlighted the association between CDI and COVID-19.[5],[6] Moreover, a case report has highlighted that combination of these two can lead to development of vascular complications like portal vein thrombosis.[7] Antibiotic stewardship and proper hygiene practices are of paramount importance to reduce the risk of CDI.

To conclude, it is highly likely that cases of CDI are being underdiagnosed and under-reported among COVID-19 patients. It is important to create an increased awareness regarding this issue and implement effective measures at local level to control this infection.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Hendaus MA, Jomha FA. COVID-19 induced superimposed bacterial infection. J Biomol Struct Dyn 2021;39:4185-91.  Back to cited text no. 1
Rawson TM, Moore LS, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and fungal coinfection in individuals with coronavirus: A rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis 2020;71:2459-68.  Back to cited text no. 2
Spigaglia P. COVID-19 and Clostridioides difficile infection (CDI): Possible implications for elderly patients. Anaerobe 2020;64:102233.  Back to cited text no. 3
Centers for Disease Control and Prevention, Office of Infectious Disease Antibiotic resistance threats in the United States, 2013. Apr, 2013. Atlanta, USA. Available from: http://www.cdc.gov/drugresistance/threat-report-2013. [Last accessed on 2021 Nov 28].  Back to cited text no. 4
Lakkasani S, Chan KH, Shaaban HS. Clostridiodes difficile in COVID-19 patients, Detroit, Michigan, USA, March-April 2020. Emerg Infect Dis 2020;26:2299-300.  Back to cited text no. 5
Sandhu A, Tillotson G, Polistico J, Salimnia H, Cranis M, Moshos J, et al. Clostridioides difficile in COVID-19 patients, Detroit, Michigan, USA, March-April 2020. Emerg Infect Dis 2020;26:2272-4.  Back to cited text no. 6
Rokkam VR, Kutti Sridharan G, Vegunta R, Vegunta R, Boregowda U, Mohan BP. Clostridium difficile and COVID-19: Novel risk factors for acute portal vein thrombosis. Case Rep Vasc Med 2021;2021:8832638.  Back to cited text no. 7


  [Table 1]


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