Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain.
Pharmacy Hospital Department, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain.
Anaerobe. 2024 Apr;86:102836. doi: 10.1016/j.anaerobe.2024.102836. Epub 2024 Feb 28.
The aim was to assess the impact of the SARS-CoV-2 pandemic on the prevalence, relative incidence (RI), incidence density (ID), ratio of rate incidence (RRI), rate of incidence density (RID), and relative risks (RR) of healthcare-onset Clostridioides difficile infection (HO-CDI) as well as its correlation with the antibiotic consumption.
Demographic and analytical data of adult patients exhibiting diarrhoea and testing positive for C. difficile were systematically collected from a tertiary care hospital in Madrid (Spain). The periods analysed included: prepandemic (P0), first pandemic-year (P1), and second pandemic-year (P2). We compared global prevalence, RI of HO-CDI per 1,000-admissions, ID of HO-CDI per 10,000-patients-days, RRI, RID, and RR. Antibiotic consumption was obtained by number of defined daily dose per 100 patient-days.
In P0, the prevalence of HO-CDI was 7.4% (IC95%: 6.2-8.7); in P1, it increased to 8.7% (IC95%: 7.4-10.1) (p = 0.2), and in P2, it continued to increase to 9.2% (IC95%: 8-10.6) (p < 0.05). During P1, the RRI was 1.5 and RID was 1.4. However, during P2 there was an increase in RRI to 1.6 and RID to 1.6. The RR also reflected the increase in HO-CDI: at P1, the probability of developing HO-CDI was 1.5 times (IC95%: 1.2-1.9) higher than P0, while at P2, this probability increased to 1.6 times (IC95%: 1.3-2.1). There was an increase in prevalence, RI, ID, RR, RRI, and RID during the two postpandemic periods respect to the prepandemic period. During P2, this increase was greater than the P1. Meropenem showed a statistically significant difference increased consumption (p < 0.05) during the pandemic period. Oral vancomycin HO-CDI treatment showed an increase during the period of study (p > 0.05).
Implementation of infection control measures during the SARS-CoV-2 pandemic did not appear to alleviate the burden of HO-CDI. The escalation in HO-CDI cases did not exhibit a correlation with overall antibiotic consumption, except for meropenem.
评估 SARS-CoV-2 大流行对医疗保健相关性艰难梭菌感染（HO-CDI）患病率、相对发病率（RI）、发病率密度（ID）、发病率比值比（RRI）、发病率密度比值比（RID）和相对风险（RR）的影响，以及其与抗生素使用量的相关性。
系统收集马德里一家三级保健医院成年腹泻且检测出艰难梭菌阳性患者的人口统计学和分析数据。分析的时间段包括：大流行前（P0）、大流行第一年（P1）和大流行第二年（P2）。我们比较了全球患病率、每 1000 例住院患者的 HO-CDI RI、每 10000 例患者天的 HO-CDI ID、RRI、RID 和 RR。抗生素使用量通过每 100 个患者天的限定日剂量数获得。
在 P0 中，HO-CDI 的患病率为 7.4%（95%CI：6.2-8.7）；在 P1 中，患病率增加至 8.7%（95%CI：7.4-10.1）（p=0.2），在 P2 中，患病率继续增加至 9.2%（95%CI：8-10.6）（p<0.05）。在 P1 期间，RRI 为 1.5，RID 为 1.4。然而，在 P2 期间，RRI 增加至 1.6，RID 增加至 1.6。RR 也反映了 HO-CDI 的增加：在 P1 期间，发生 HO-CDI 的概率是 P0 的 1.5 倍（95%CI：1.2-1.9），而在 P2 期间，这一概率增加到 1.6 倍（95%CI：1.3-2.1）。在两个大流行后时期，HO-CDI 的患病率、RI、ID、RR、RRI 和 RID 均高于大流行前时期。在 P2 期间，这种增加大于 P1。在大流行期间，美罗培南的使用量呈统计学显著增加（p<0.05）。在研究期间，口服万古霉素治疗 HO-CDI 的使用量增加（p>0.05）。
在 SARS-CoV-2 大流行期间实施感染控制措施似乎并未减轻 HO-CDI 的负担。除了美罗培南外，HO-CDI 病例的增加与总体抗生素使用量之间没有相关性。
