Brief Report
Trends in Clostridioides difficile infection across a public health hospital system in New York City 2019-2021: A cautionary note

https://doi.org/10.1016/j.ajic.2022.04.015Get rights and content

Highlights

  • Healthcare facility-onset Clostridioides difficile infection across an 11-hospital system rose after the spring of 2020.

  • The reason for the increase in C. difficile infections is multifactorial.

  • The increase in C. difficile during the spring of 2020 correlated with an increase in cephalosporin use.

Contrary to national reports, rates of healthcare facility-onset Clostridioides difficile infection across an 11-hospital system rose after the spring of 2020, when New York City was the epicenter for the COVID-19 pandemic. Antibiotic pressure from an escalation in cephalosporin usage correlated with this increase. The majority of cases of Clostridioides difficile were in patients without COVID-19, suggesting the pandemic has adversely impacted the healthcare of other inpatients.

Section snippets

Methods

Data was obtained from National Hospital Safety Network (NHSN) for 11 hospitals belonging the NYC Health + Hospital Enterprise, as previously reported.4 All 11 hospitals are academic, tertiary care, major medical centers. While there are centralized policies, all have their own designated administration, antibiotic stewardship program and clinical staff. A small subset of patients may be referred from one facility to another for specialized services (eg, cardiothoracic surgery). Line listings

Results

From 2019Q1 through 2020Q1, there were progressive declines in the number of patients with healthcare facility-onset C. difficile and standardized infection ratios (SIRs) for the 11-hospital system (Fig 1). However, in the spring of 2020, this trend was reversed. Segmented regression analysis revealed a marked increase (P = .085) in rates at the breakpoint 2020Q2. Approximately one-third of cases with C. difficile in 2020Q2 were in patients with COVID-19. For the following year after the surge,

Discussion

Contrary to national reports,2,3 we observed an increase in healthcare facility-onset C. difficile infections following the initial surge of COVID-19 in NYC hospitals. A marked increase in cephalosporin usage coincided with the initial surge; usage continued to remain above baseline for the subsequent months. In 1 report elevated rates of C. difficile among patients with COVID-19 were attributed to greater healthcare exposure and antibiotic use.5 In our study, during the initial surge

References (10)

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Conflicts of interest: None to report.

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