Cargando…

Did Clostridioides difficile Testing and Infection Rates Change During the COVID-19 Pandemic?

Background: The COVID-19 pandemic has underscored the importance of ongoing infection prevention efforts. Increased adherence to infection prevention recommendations, increased antibiotic use, improved hand hygiene, and correct donning and doffing of personal protective equipment may have influenced...

Descripción completa

Detalles Bibliográficos
Autores principales: Hawes, Armani, Patel, Payal, Desai, Angel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9551597/
http://dx.doi.org/10.1017/ash.2021.79
_version_ 1784806139979890688
author Hawes, Armani
Patel, Payal
Desai, Angel
author_facet Hawes, Armani
Patel, Payal
Desai, Angel
author_sort Hawes, Armani
collection PubMed
description Background: The COVID-19 pandemic has underscored the importance of ongoing infection prevention efforts. Increased adherence to infection prevention recommendations, increased antibiotic use, improved hand hygiene, and correct donning and doffing of personal protective equipment may have influenced healthcare-associated infections (HAIs) in the United States during the pandemic. In this study, we investigated testing for Clostridioides difficile infection (CDI) and incidence during the initial surge of the pandemic. We hypothesized that strict adherence to contact precautions may have resulted in a decreased incidence of CDI in hospitalized patients during the first peak of the COVID-19 pandemic and that CDI testing may have increased even in the absence of directed diagnostic stewardship efforts. Methods: We conducted a single-center, retrospective, observational study at the Veterans’ Affairs (VA) Hospital in Ann Arbor, Michigan, between January 2019 and June 2020. We compared data on CDI tests from January 2019 through February 2020 to data from March 2020 (the admission of the first patient with COVID-19 at our institution) through June 2020. Pre-peak and peak periods were defined by confirmed cases in Washtenaw County. No novel diagnostic or CDI-focused stewardship interventions were introduced by the antimicrobial stewardship program during the study period. An interrupted time series analysis was performed using STATA version 16.1 software (StataCorp LLC, College Station, TX). Results: There were 6,525 admissions and 34,533 bed days between January 1, 2019, and June 30, 2020. Also, 900 enzyme immunoassay (EIA) tests were obtained and 104 positive cases of CDI were detected between January 2019 and June 2020. A statistically significant decrease in EIA tests occurred after March 1, 2020 (the COVID-19 peak in our region) compared to January 1, 2019–March 1, 2020 (Figure 1). After March 1, 2020, the number of EIA tests obtained decreased by 10.2 each month (95% CI, −18.7 to −1.7; P = .02). No statistically significant change in the incidence of CDI occurred. The use of antibiotics that were defined as high risk for CDI increased in the months of April–June 2020 (Figure 2). Conclusions: In this single-center study, we observed a stable incidence of CDI but decreased testing during the first peak of the COVID-19 pandemic. Understanding local HAI reporting is critical because changes in HAI reporting structures and exemptions during this period may have affected national reporting. Further research should be undertaken to investigate the effect of COVID-19 on other HAI reporting within the US healthcare system. Funding: No Disclosures: None
format Online
Article
Text
id pubmed-9551597
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Cambridge University Press
record_format MEDLINE/PubMed
spelling pubmed-95515972022-10-12 Did Clostridioides difficile Testing and Infection Rates Change During the COVID-19 Pandemic? Hawes, Armani Patel, Payal Desai, Angel Antimicrob Steward Healthc Epidemiol C. difficile Background: The COVID-19 pandemic has underscored the importance of ongoing infection prevention efforts. Increased adherence to infection prevention recommendations, increased antibiotic use, improved hand hygiene, and correct donning and doffing of personal protective equipment may have influenced healthcare-associated infections (HAIs) in the United States during the pandemic. In this study, we investigated testing for Clostridioides difficile infection (CDI) and incidence during the initial surge of the pandemic. We hypothesized that strict adherence to contact precautions may have resulted in a decreased incidence of CDI in hospitalized patients during the first peak of the COVID-19 pandemic and that CDI testing may have increased even in the absence of directed diagnostic stewardship efforts. Methods: We conducted a single-center, retrospective, observational study at the Veterans’ Affairs (VA) Hospital in Ann Arbor, Michigan, between January 2019 and June 2020. We compared data on CDI tests from January 2019 through February 2020 to data from March 2020 (the admission of the first patient with COVID-19 at our institution) through June 2020. Pre-peak and peak periods were defined by confirmed cases in Washtenaw County. No novel diagnostic or CDI-focused stewardship interventions were introduced by the antimicrobial stewardship program during the study period. An interrupted time series analysis was performed using STATA version 16.1 software (StataCorp LLC, College Station, TX). Results: There were 6,525 admissions and 34,533 bed days between January 1, 2019, and June 30, 2020. Also, 900 enzyme immunoassay (EIA) tests were obtained and 104 positive cases of CDI were detected between January 2019 and June 2020. A statistically significant decrease in EIA tests occurred after March 1, 2020 (the COVID-19 peak in our region) compared to January 1, 2019–March 1, 2020 (Figure 1). After March 1, 2020, the number of EIA tests obtained decreased by 10.2 each month (95% CI, −18.7 to −1.7; P = .02). No statistically significant change in the incidence of CDI occurred. The use of antibiotics that were defined as high risk for CDI increased in the months of April–June 2020 (Figure 2). Conclusions: In this single-center study, we observed a stable incidence of CDI but decreased testing during the first peak of the COVID-19 pandemic. Understanding local HAI reporting is critical because changes in HAI reporting structures and exemptions during this period may have affected national reporting. Further research should be undertaken to investigate the effect of COVID-19 on other HAI reporting within the US healthcare system. Funding: No Disclosures: None Cambridge University Press 2021-07-29 /pmc/articles/PMC9551597/ http://dx.doi.org/10.1017/ash.2021.79 Text en © The Society for Healthcare Epidemiology of America 2021 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle C. difficile
Hawes, Armani
Patel, Payal
Desai, Angel
Did Clostridioides difficile Testing and Infection Rates Change During the COVID-19 Pandemic?
title Did Clostridioides difficile Testing and Infection Rates Change During the COVID-19 Pandemic?
title_full Did Clostridioides difficile Testing and Infection Rates Change During the COVID-19 Pandemic?
title_fullStr Did Clostridioides difficile Testing and Infection Rates Change During the COVID-19 Pandemic?
title_full_unstemmed Did Clostridioides difficile Testing and Infection Rates Change During the COVID-19 Pandemic?
title_short Did Clostridioides difficile Testing and Infection Rates Change During the COVID-19 Pandemic?
title_sort did clostridioides difficile testing and infection rates change during the covid-19 pandemic?
topic C. difficile
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9551597/
http://dx.doi.org/10.1017/ash.2021.79
work_keys_str_mv AT hawesarmani didclostridioidesdifficiletestingandinfectionrateschangeduringthecovid19pandemic
AT patelpayal didclostridioidesdifficiletestingandinfectionrateschangeduringthecovid19pandemic
AT desaiangel didclostridioidesdifficiletestingandinfectionrateschangeduringthecovid19pandemic