Clostridioides difficile and vancomycin‐resistant enterococci in covid‐19 patients with severe pneumonia

Abstract

Broad‐spectrum antibiotics administered to patients with severe COVID‐19 pneumonia pose a risk of infection caused by Clostridioides difficile. This risk is reduced mainly by strict hygiene measures and early de‐escalation of antibiotic therapy. Recently, oral vancomycin prophylaxis (OVP) has also been discussed. This retrospective study aimed to assess the prevalence of C. difficile in critical COVID‐19 patients staying in an intensive care unit of a tertiary hospital department of anesthesiology, resuscitation, and intensive care from November 2020 to May 2021 and the rates of vancomycin‐resistant enterococci (VRE) after the introduction of OVP and to compare the data with those from controls in the pre‐pandemic period (November 2018 to May 2019). During the COVID‐ 19 pandemic, there was a significant increase in toxigenic C. difficile rates to 12.4% of patients, as compared with 1.6% in controls. The peak rates were noted in February 2021 (25% of patients), immediately followed by initiation of OVP, changes to hygiene precautions, and more rapid de‐escalation of antibiotic therapy. Subsequently, toxigenic C. difficile detection rates started to fall. There was a nonsignificant increase in VRE detected in non‐gastrointestinal tract samples to 8.9% in the COVID‐19 group, as compared to 5.3% in the control group. Molecular analysis confirmed mainly clonal spread of VRE.