Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection

Kanika Sehgal,1 Hind J Fadel,2 Aaron J Tande,2 Darrell S Pardi,1 Sahil Khanna1 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA; 2Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USACorrespondence: Sahil KhannaDivision of Gastroenterology and Hepatology, Mayo...

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Main Authors: Sehgal K, Fadel HJ, Tande AJ, Pardi DS, Khanna S
Format: Article
Language:English
Published: Dove Medical Press 2021-04-01
Series:Infection and Drug Resistance
Subjects:
Online Access:https://www.dovepress.com/outcomes-in-patients-with-sars-cov-2-and-clostridioides-difficile-coin-peer-reviewed-fulltext-article-IDR
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spelling doaj-34e4b75e034c4962a359983c475accb72021-04-29T19:52:47ZengDove Medical PressInfection and Drug Resistance1178-69732021-04-01Volume 141645164864283Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile CoinfectionSehgal KFadel HJTande AJPardi DSKhanna SKanika Sehgal,1 Hind J Fadel,2 Aaron J Tande,2 Darrell S Pardi,1 Sahil Khanna1 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA; 2Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USACorrespondence: Sahil KhannaDivision of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USATel +1 507-266-4347Fax +1 507-293-3917Email Khanna.sahil@mayo.eduBackground: Coronavirus infectious disease 2019 (COVID-19) is primarily a respiratory disease. However, it may manifest with gastrointestinal symptoms that may overlap with Clostridioides difficile infection (CDI). COVID-19 appears to have higher mortality in those with comorbidities. We aimed to assess the outcomes of coinfection in these patients.Methods: A retrospective chart review was conducted to identify patients with CDI and COVID-19 from January 1st, 2020 to November 17th, 2020. Both infections were diagnosed via PCR. Clinical features, treatment for COVID-19 and CDI and outcomes including intensive care unit admission, colectomy, 30 day-mortality and long-term complications were analyzed.Results: Overall, 21 patients (20 hospitalized) with median age 70.9 years (range 51.8– 90.7 years) had CDI and COVID-19 within 4 weeks of each other. Of these, 4 patients (19%) with CDI were diagnosed with COVID-19 at the time of admission, 12 (57%) had CDI diagnosed after COVID-19, and 5 (23.9%) developed COVID-19 within 4 weeks after CDI. Fourteen patients (66.7%) were treated with medications directed against COVID-19 including remdesivir and dexamethasone (n=7), remdesivir with convalescent plasma (n= 1), remdesivir (n= 5) and dexamethasone (n=1). The most common treatment for CDI was oral vancomycin in 20 patients (95.2%), and 1 patient received intravenous metronidazole. No patient required colectomy for CDI but 2 (9.5%) required ICU admission. Four patients (19%) died likely due to COVID-19 with median age 80 years (range 61– 90 years).Conclusion: The relationship between COVID-19 and CDI is poorly understood, and studies are required to further investigate this association. Whether coinfection results in a worsening of outcomes, including mortality and clinical course, are questions that should be answered in future research studies. Diagnosing both infections for appropriate management is vital in light of overlapping symptoms.Keywords: diarrhea, infection, C. difficile, microbiome, antibiotics, COVID-19, mortalityhttps://www.dovepress.com/outcomes-in-patients-with-sars-cov-2-and-clostridioides-difficile-coin-peer-reviewed-fulltext-article-IDRdiarrheainfectionc difficilemicrobiomeantibioticscovid-19mortality
collection DOAJ
language English
format Article
sources DOAJ
author Sehgal K
Fadel HJ
Tande AJ
Pardi DS
Khanna S
spellingShingle Sehgal K
Fadel HJ
Tande AJ
Pardi DS
Khanna S
Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection
Infection and Drug Resistance
diarrhea
infection
c difficile
microbiome
antibiotics
covid-19
mortality
author_facet Sehgal K
Fadel HJ
Tande AJ
Pardi DS
Khanna S
author_sort Sehgal K
title Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection
title_short Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection
title_full Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection
title_fullStr Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection
title_full_unstemmed Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection
title_sort outcomes in patients with sars-cov-2 and clostridioides difficile coinfection
publisher Dove Medical Press
series Infection and Drug Resistance
issn 1178-6973
publishDate 2021-04-01
description Kanika Sehgal,1 Hind J Fadel,2 Aaron J Tande,2 Darrell S Pardi,1 Sahil Khanna1 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA; 2Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USACorrespondence: Sahil KhannaDivision of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USATel +1 507-266-4347Fax +1 507-293-3917Email Khanna.sahil@mayo.eduBackground: Coronavirus infectious disease 2019 (COVID-19) is primarily a respiratory disease. However, it may manifest with gastrointestinal symptoms that may overlap with Clostridioides difficile infection (CDI). COVID-19 appears to have higher mortality in those with comorbidities. We aimed to assess the outcomes of coinfection in these patients.Methods: A retrospective chart review was conducted to identify patients with CDI and COVID-19 from January 1st, 2020 to November 17th, 2020. Both infections were diagnosed via PCR. Clinical features, treatment for COVID-19 and CDI and outcomes including intensive care unit admission, colectomy, 30 day-mortality and long-term complications were analyzed.Results: Overall, 21 patients (20 hospitalized) with median age 70.9 years (range 51.8– 90.7 years) had CDI and COVID-19 within 4 weeks of each other. Of these, 4 patients (19%) with CDI were diagnosed with COVID-19 at the time of admission, 12 (57%) had CDI diagnosed after COVID-19, and 5 (23.9%) developed COVID-19 within 4 weeks after CDI. Fourteen patients (66.7%) were treated with medications directed against COVID-19 including remdesivir and dexamethasone (n=7), remdesivir with convalescent plasma (n= 1), remdesivir (n= 5) and dexamethasone (n=1). The most common treatment for CDI was oral vancomycin in 20 patients (95.2%), and 1 patient received intravenous metronidazole. No patient required colectomy for CDI but 2 (9.5%) required ICU admission. Four patients (19%) died likely due to COVID-19 with median age 80 years (range 61– 90 years).Conclusion: The relationship between COVID-19 and CDI is poorly understood, and studies are required to further investigate this association. Whether coinfection results in a worsening of outcomes, including mortality and clinical course, are questions that should be answered in future research studies. Diagnosing both infections for appropriate management is vital in light of overlapping symptoms.Keywords: diarrhea, infection, C. difficile, microbiome, antibiotics, COVID-19, mortality
topic diarrhea
infection
c difficile
microbiome
antibiotics
covid-19
mortality
url https://www.dovepress.com/outcomes-in-patients-with-sars-cov-2-and-clostridioides-difficile-coin-peer-reviewed-fulltext-article-IDR
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