Comparison of Clostridioides difficile Infection Incidence in a General and a Geriatric Hospital Prior to and During the COVID-19 Pandemic

Background: Clostridioides difficile (CD) is the main cause of nosocomial diarrhea, resulting in increased morbidity and mortality, and is thought to be greatly affected by strict hygiene. In this study, we assessed changes in CD infection prevalence and outcomes pre- and during the COVID-19 pandemic (CP). Methods: This was an observational cohort performed at a tertiary medical center (MC) and a geriatric hospital (GH). Patients from both hospitals diagnosed with CD were included, and the period of one year prior to the pandemic to one year after was compared. Data was extracted from electronic medical records (EMR). Results: A total of 145 CD-associated diarrhea (CDAD) cases were diagnosed in the MC and 54 in the GH. There was no change in CDAD prevalence or mortality between the study periods in either hospital. Disease duration, measured as days with diarrhea (DWD), was shorter during the CP in the GH (10.6 days vs. 8.1 days, p < 0.01). CDAD was more prevalent in the GH during both periods; however, the disease was milder, with only three mortality cases and a significantly shorter disease duration (3.19 DWD vs. 10.67 in the MC before CP; 3.11 vs. 8.1 during CP, p < 0.01). In a survival analysis for MC patients, no significant differences were found between periods before and after adjustment for age, gender and period. Conclusions: The CP affected the duration but not the prevalence of CDAD. The milder course of CDAD in the GH may have been due to the quality of treatment provided in an academic GH and the subsequent faster diagnosis and treatment.