COVID-19 infection and correlation of clostridium difficile colitis in elderly patients

Introduction: Clostridium difficile infection (C. difficile) occurs in prolonged antibiotic and PPI treatment or in immunocompromised patients. In the Covid-19 pandemic, the link between C. difficile colitis and Sars-Cov 2 infection is highlighted. Aims & Methods: A prospective study that includes 162 patients with C. difficile infection (with an equal male/female sex ratio, 63% in urban regions, 47.2% in rural areas, average 75 years old) is made starting with May 2020 - April 2021 so far and evaluates hospitalized patients at Hospital St. Spiridon Iasi for C. difficile infection with their distribution by age, gender, living environment and the relationship with Sars-Cov 2 infection and its treatment, as well as with other associated infections. The patients were tested for COVID-19 infection by PCR and chest X-ray, also biologically explored and investigated by abdominal ultrasound, CT scan and colonoscopy. Results: Of the total patients, 38 cases had Sars-Cov 2 infection (23.4%). Of these,19 patients (50%) had symptom onset one week after confirmation of Covid-19 infection, 13.6% at 2 weeks, 18.7% at one month and 17.6% over one month. 17 cases (44.7%) performed antibiotic therapy for Sars-Cov 2 infection, 5 cases had no treatment (14.2%), and in 16 patients we have no data (41.1%). In 43 cases (26.5%) from the total lot with C. difficile, other associated infections were detected (pulmonary, urinary, spontaneous bacterial peritonitis and sepsis). Treatment recommended for C. difficile infection was with: Vancomycin 500mg/day in 40,2% patients, Vancomycin 1 g/day in 24,5% and combination of Vancomycin with Metronidazole in 35.3% cases). Among patients with C. difficile and Sars-Cov 2 infection, 30 cases (78.9%) associated cardiovascular and metabolic comorbidities. 9 patients with C. difficile and severe Covid-19 infection died. (23.6% of deaths). Conclusion: Covid-19 infection was detected in 23,4% of patients with C. difficile. The relationship between these infections is explained by antibiotic treatment given for Sars-Cov 2 infection, advanced age and the presence of comorbidities in 78.9% of patients. Further studies would be useful to confirm our study.