Wright Lorinda M, Skinner Andrew M, Cheknis Adam, McBurney Conor, Ge Ling, Pacheco Susan M, Leehey David, Gerding Dale N, Johnson Stuart
Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA.
Chicago Stritch School of Medicine, Loyola University, 2160 S. First Ave., Maywood, IL 60153, USA.
Antibiotics (Basel). 2023 Jul 7;12(7):1159. doi: 10.3390/antibiotics12071159.
The COVID-19 pandemic was associated with increases in some healthcare-associated infections. We investigated the impact of the pandemic on the rates and molecular epidemiology of infection (CDI) within one VA hospital. We anticipated that the potential widespread use of antibiotics for pneumonia during the pandemic might increase CDI rates given that antibiotics are a major risk for CDI. Hospital data on patients with CDI and recurrent CDI (rCDI) were reviewed both prior to the COVID-19 pandemic (2015 to 2019) and during the pandemic (2020-2021). Restriction endonuclease analysis (REA) strain typing was performed on CD isolates recovered from stool samples collected from October 2019 to March 2022. CDI case numbers declined by 43.2% in 2020 to 2021 compared to the annual mean over the previous 5 years. The stool test positivity rate was also lower during the COVID-19 pandemic (14.3% vs. 17.2%; = 0.013). Inpatient hospitalization rates declined, and rates of CDI among inpatients were reduced by 34.2% from 2020 to 2021. The mean monthly cases of rCDI also declined significantly after 2020 [3.38 (95% CI: 2.89-3.87) vs. 1.92 (95% CI: 1.27-2.56); = <0.01]. Prior to the pandemic, REA group Y was the most prevalent CD strain among the major REA groups (27.3%). During the first wave of the pandemic, from 8 March 2020, to 30 June 2020, there was an increase in the relative incidence of REA group BI (26.7% vs. 9.1%); After adjusting for CDI risk factors, a multivariable logistic regression model revealed that the odds of developing an REA group BI CDI increased during the first pandemic wave (OR 6.41, 95% CI: 1.03-39.91) compared to the pre-pandemic period. In conclusion, the incidence of CDI and rCDI decreased significantly during the COVID-19 pandemic. In contrast, REA BI (Ribotype 027), a virulent, previously epidemic CD strain frequently associated with hospital transmission and outbreaks, reappeared as a prevalent strain during the first wave of the pandemic, but subsequently disappeared, and overall CDI rates declined.
新冠疫情与某些医疗保健相关感染的增加有关。我们调查了疫情对一家退伍军人事务医院内艰难梭菌感染（CDI）的发病率和分子流行病学的影响。我们预计，疫情期间肺炎抗生素的潜在广泛使用可能会增加CDI发病率，因为抗生素是CDI的主要风险因素。我们回顾了新冠疫情之前（2015年至2019年）和疫情期间（2020 - 2021年）医院关于CDI和复发性CDI（rCDI）患者的数据。对2019年10月至2022年3月收集的粪便样本中分离出的艰难梭菌进行了限制性内切酶分析（REA）菌株分型。与前5年的年平均水平相比，2020年至2021年CDI病例数下降了43.2%。在新冠疫情期间，粪便检测阳性率也较低（14.3%对17.2%；P = 0.013）。住院率下降，2020年至2021年住院患者中的CDI发病率降低了34.2%。2020年后rCDI的平均每月病例数也显著下降[3.38（95%CI：2.89 - 3.87）对1.92（95%CI：1.27 - 2.56）；P = <0.01]。在疫情之前，REA Y组是主要REA组中最常见的艰难梭菌菌株（27.3%）。在疫情的第一波期间，从2020年3月8日至2020年6月30日，REA BI组的相对发病率有所增加（26.7%对9.1%）；在调整CDI风险因素后，多变量逻辑回归模型显示，与疫情前相比，在疫情第一波期间发生REA BI组CDI的几率增加（OR 6.41，95%CI：1.03 - 39.91）。总之，在新冠疫情期间，CDI和rCDI的发病率显著下降。相比之下，REA BI（核糖型027）是一种毒性强、以前流行的艰难梭菌菌株，经常与医院传播和暴发有关，在疫情第一波期间作为流行菌株再次出现，但随后消失，总体CDI发病率下降。
