EVOLUTION OF CLOSTRIDIOIDES DIFFICILE INFECTIONS DURING THE COVID-19 PANDEMIC: A RETROSPECTIVE OBSERVATIONAL STUDY AT A TERTIARY UNIVERSITY HOSPITAL
DOI:
https://doi.org/10.22551/MSJ.2026.03.19Abstract
Clostridioides difficile infection (CDI) is a major cause of healthcare-associated diarrhea. This study aimed to analyze the clinical course and characteristics of patients diagnosed at a tertiary university hospital in northeastern Romania between 2020 and May 2023. Materials and methods: This retrospective observational study included 2,317 adult patients with CDI confirmed clinically and microbiologically, colonoscopically, or histopathologically, who were hospitalized between January 2020 and May 2023. Data from medical records were analyzed descriptively using SPSS 18.0, employing frequencies, percentages, and measures of central tendency and dispersion. Results: The number of CDI cases increased progressively from 2020 to 2022 (rising from 540 to 811), with 290 cases recorded between January and May 2023. Men accounted for 59.6% of the cohort; the mean age was 62.82 ± 15.67 years, with a median age of 65 years. Patients from urban areas represented 57.7% of the total. A combination of toxins A and B was identified in 79.6% of cases. Healthcare-associated CDI accounted for 50.1% of cases, and 50.5% of patients had experienced at least one hospitalization in the preceding year. Recent exposure to acid-suppressive medication was noted in 64.4% of patients, antibiotic therapy in 24.3%, and surgery within the previous two weeks in 13.4%. Immunocompromised patients constituted 55.3% of the group, and recurrence occurred in 9.5% of cases. Conclusions: The profile of patients with Clostridioides difficile infection was characterized by advanced age, prior hospitalizations, and recent exposure to acid-suppressive medication and antibiotics. The results highlight the need for active surveillance and early identification of high-risk patients to reduce the impact of CDI in the hospital setting.
References
1. Banawas SS. Clostridium difficile Infections: A Global Overview of Drug Sensitivity and Re-sistance Mechanisms. Biomed Res Int 2018; 2018: 8414257.
2. Marinescu AR, Laza R, Musta VF, et al. Clostridium Difficile and COVID-19: General Data, Ribotype, Clinical Form, Treatment-Our Experience from the Largest Infectious Diseases Hospital in Western Romania. Medicina (Kaunas) 2021; 57(10): 1099.
3. Tariq R, Saha S, Furqan F, Hassett L, Pardi D, Khanna S. Prevalence and Mortality of COVID-19 Patients with Gastrointestinal Symptoms: A Systematic Review and Meta-analysis. Mayo Clin Proc 2020; 95(8): 1632-1648.
4. Spigaglia P. Clostridioides difficile infection (CDI) during the COVID-19 pandemic. Anaerobe 2022; 74: 102518.
5. Weiner-Lastinger LM, Pattabiraman V, Konnor RY, et al. The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network [published correction appears in Infect Control Hosp Epidemiol. 2022 Jan; 43(1): 137. doi: 10.1017/ice.2022.10]. Infect Control Hosp Epidemiol 2022; 43(1): 12-25.
6. Sipos S, Vlad C, Prejbeanu R, et al. Impact of COVID-19 prevention measures on Clostridioides difficile infections in a regional acute care hospital. Exp Ther Med 2021; 22(5): 1215.
7. Lewandowski K, Rosołowski M, Kaniewska M, et al. Clostridioides difficile infection in coro-navirus disease 2019 (COVID-19): an underestimated problem? Pol Arch Intern Med 2021; 131(2): 121-127.
8. Karampatakis T, Tsergouli K, Kandilioti E, Nikopoulou A, Katsifa H, Kachrimanidou M. Impli-cation of COVID-19 pandemic on the incidence of Clostridioides difficile infection in a Greek tertiary hospital. J Med Microbiol 2023; 72(5): 10.1099/jmm.0.001689.
9. Eeuwijk J, Ferreira G, Yarzabal JP, Robert-Du Ry van Beest Holle M. A Systematic Literature Review on Risk Factors for and Timing of Clostridioides difficile Infection in the United States. Infect Dis Ther 2024; 13(2): 273-298.
10. Di Bella S, Sanson G, Monticelli J, et al. Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options. Clin Microbiol Rev 2024; 37(2): e0013523.
11. Zhang S, Ma C, Zhang H, et al. Toxin genotypes, antibiotic resistance and their correlations in Clostridioides difficile isolated from hospitals in Xi'an, China. BMC Microbiol 2024; 24(1): 177.
12. Costa DVS, Pham NVS, Hays RA, et al. Influence of Binary Toxin Gene Detection and De-creased Susceptibility to Antibiotics among Clostridioides difficile Strains on Disease Severity: a Single-Center Study. Antimicrob Agents Chemother 2022; 66(8): e0048922.
13. Cao F, Chen CX, Wang M, et al. Updated meta-analysis of controlled observational studies: proton-pump inhibitors and risk of Clostridium difficile infection. J Hosp Infect. 2018; 98(1): 4-13.
14. Columbo JA, Scali ST, Neal D, et al. Postoperative Clostridium difficile infection has a differ-ential procedure-specific association with surgical outcomes in contemporary United States practice. Surgery. 2023; 173(4): 1015-1022.
15. Kim YI, Yu CS, Kim YS, et al. Clostridium difficile infection after ileostomy closure and anas-tomotic failure in rectal cancer surgery patients. BJS Open 2022; 6(2): zrac026.
16. Guh AY, Li R, Korhonen L, et al. Characteristics of Patients with Initial Clostridioides difficile Infection (CDI) That Are Associated with Increased Risk of Multiple CDI Recurrences. Open Forum Infect Dis 2024; 11(4): ofae127.
17. Finn E, Andersson FL, Madin-Warburton M. Burden of Clostridioides difficile infection (CDI) - a systematic review of the epidemiology of primary and recurrent CDI. BMC Infect Dis. 2021; b21(1): b456.
18. Matei MC, Chirica VA, Ifrim M, et al. Antibiotic Consumption and Healthcare-Associated Infection Surveillance in a Multi-Unit Emergency Hospital in Romania: A Retrospective Obser-vational Study. Medicina (Kaunas). 2026; 62(6): 1171.
19. Lacatusu GA, Hunea I, Iordan IF, Vasilescu C, Stamateanu O, Manciuc C. Risk factors associated with recurrence of Clostridioides difficile infection. Med-Surg J-Rev Med Chir Soc Med Nat Iasi 2020; 124(2): 200-206.
Additional Files
Published
Issue
Section
License
Copyright (c) 2026 The Medical-Surgical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
COPYRIGHT
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.
COPYRIGHT TRANSFER FORM FOR
REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /
THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI
We, the undersigned authors of the manuscript entitled
_____________________________________________________________________________________
_____________________________________________________________________________________
warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.
- we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
- the manuscript does not break the intellectual property rights of any other person.
- we have read the submitted version of the manuscript and we are fully responsible for the content.
Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):
- ______________________________/_________________________
- ______________________________/_________________________
- ______________________________/_________________________
N.B. All the authors must sign this form
