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Meta-Analysis
. 2022 Apr:74:102484.
doi: 10.1016/j.anaerobe.2021.102484. Epub 2021 Nov 26.

The burden of Clostridioides difficile infection in COVID-19 patients: A systematic review and meta-analysis

Guido Granata  1 , Nicola Petrosillo  2 , Samir Al Moghazi  1 , Emanuela Caraffa  1 , Vincenzo Puro  3 , Glenn Tillotson  4 , Maria Adriana Cataldo  3
Affiliations
Meta-Analysis

The burden of Clostridioides difficile infection in COVID-19 patients: A systematic review and meta-analysis

Guido Granata et al. Anaerobe. 2022 Apr.

Abstract

Objectives: The main aim of this systematic review and meta-analysis was to assess the proportion of confirmed COVID-19 patients with Clostridioides difficile infection (CDI) and to describe risk factors and outcome of these patients.

Methods: MEDLINE and Cochrane Central Register of Controlled Trials databases were searched up to July 15, 2021. We included studies reporting data on CDI occurring in patients with a confirmed diagnosis of COVID-19. We pooled proportion of CDI patients using a random effects model (DerSimonian-Laird method) stabilising the variances using the Freeman-Tukey double arcsine transformation.

Results: Thirteen studies were included in the systematic review. All the studies retrospectively collected data between February 2020 and February 2021. The reported CDI incidence rates ranged from 1.4 to 4.4 CDI cases per 10,000 patient-days. Seven studies reported data on the number of COVID-19 patients who developed CDI and the total number of COVID-19 patients in the study period and were included in the meta-analysis, comprising 23,697 COVID-19 patients. The overall pooled proportion of COVID-19 patients who had CDI was 1% [95% confidence interval: 1-2]. Among studies reporting CDI occurrence in patients with and without COVID-19, the majority of them reported reduced or unchanged CDI rates compared to pre-COVID period.

Conclusions: CDI is a relevant issue for COVID-19 patients. Adherence to infection prevention and control measures and to the antimicrobial stewardship principles is crucial even during the COVID-19 pandemic.

Keywords: Antibiotic use; CDI prevalence; Clostridioides difficile infection; Coronavirus disease 2019 pandemic; Infection control measures; Meta analysis; Risk factors.

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Conflict of interest statement

Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flowchart depicting the selection process of studies included in the systematic review.
Fig. 2
Fig. 2
Pooled proportion of COVID-19 patients who had CDI Legend: ES, Estimated proportion.
Fig. 3
Fig. 3
Pooled proportion of COVID-19 patients who had hospital-onset CDI Legend: ES, Estimated proportion.
See this image and copyright information in PMC

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