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. 2021 Oct 22;11(11):1127.
doi: 10.3390/life11111127.

Clostridioides difficile and Vancomycin-Resistant Enterococci in COVID-19 Patients with Severe Pneumonia

Kateřina Bogdanová  1 , Lenka Doubravská  2 , Iva Vágnerová  1 , Kristýna Hricová  3 , Vendula Pudová  3 , Magdaléna Röderová  3 , Jan Papajk  2 , Radovan Uvízl  2 , Kateřina Langová  4 , Milan Kolář  1
Affiliations

Clostridioides difficile and Vancomycin-Resistant Enterococci in COVID-19 Patients with Severe Pneumonia

Kateřina Bogdanová et al. Life (Basel). .

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.

Keywords: COVID-19; Clostridioides difficile; ICU; molecular typing of VRE; oral vancomycin prophylaxis; vancomycin-resistant enterococci.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
C. difficile statistical analysis. We compared the numbers of performed C. difficile detection tests and the numbers C. difficile positive cases (antigen-positive) and C. difficile-toxin positive cases among hospitalized patients. We detected a significant increase (p < 0.0005) in COVID-19 compared to the control group in all three aspects (number of performed tests, number of CD positive cases, and number of positive CD-toxins). CD: Clostridioides difficile.
Figure 2
Figure 2
VRE cases between 1 November 2020 and 31 May 2021. For April and May, when the VRE screening was performed, the total number of detected VRE is shown, including VRE detected in both GIT and non-GIT samples collected from the same patient.
Figure 3
Figure 3
Vancomycin-resistant enterococci (VRE) statistical analysis. We performed the statistical analysis of VRE detected in non-GIT: endotracheal aspirate, blood cultures, and urine. According to our findings, there was no statistically significant increase in the COVID-19 group compared to the control group (p = 0.132). VRE: vancomycin-resistant enterococci; ETA: endotracheal aspirate.
Figure 4
Figure 4
Dendrogram of 50 vancomycin-resistant Enterococcus faecium isolates.
Figure 5
Figure 5
Timeline of the prevalence of VRE clones throughout the study duration. The grey rectangles represent 5 clonal groups of vancomycin-resistant Enterococcus faecium based on their similarity. Individual isolates are represented by the symbols ●□○+▲ within clusters. Six strains with unique profiles are marked with ∗.
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