How Did COVID-19 Affect Clostridioides Difficile Testing and Incidence Rates?

In the late winter and early spring of 2020, a shift occurred in healthcare to address the impending COVID-19 pandemic. Cases began to increase significantly, and almost overnight in March, the entire United States began to focus solely on SARS-CoV-2.

Screenings and elective surgeries were cancelled and reporting for healthcare-associated infections (HAI) became optional. At the Veterans Administration hospital in Ann Arbor, Michigan a small team took up a study looking to see if CDI testing and infection rates changed during this first surge of the pandemic.

The study was led by Armani Hawes, MD, and Payal K. Patel, MD, MPH, Division of Infectious Diseases assistant professor, University of Michigan Health System Medical Director of Antimicrobial Stewardship, VA Ann Arbor. They presented a poster virtually at The Society for Healthcare Epidemiology of America (SHEA) back in April and the work was just published in Anaerobe.

“As the pandemic started to get into full swing, we started to think about how all these healthcare-associated infections might be affected,” Hawes said about the study team’s motivation for the study. She said there were other variables including additional infection prevention factors in place because of COVID-19 and the Centers for Medicare and Medicaid's decision to stop mandatory reporting on all HAI including C diff.

The investigators conducted a single center, retrospective, observational study at the VA Hospital in Ann Arbor between January 2019 and June 2020. They compared data from CDI tests from January 2019 through February 2020 to data from March 2020—the first admission of patient with COVID-19 at the VA—through June 2020.

Between January 1, 2019 and June 30, 2020 there were 6525 total admissions and 34,533 bed days. There were 900 enzyme immunoassay (EIA) tests obtained and 104 positive cases of CDI between January 2019 and June 2020.

In terms of testing, there were some noted differences. “There was a statistically significant decrease in EIA tests after March 1, 2020 (the COVID-19 peak in their region), compared to January 1, 2019-March 1,2020,” the investigators wrote in the poster. “After March 1, 2020 the number of EIA tests obtained decreased by 10.2 each month (95% Confidence Interval [CI] -18.7 to -1.7; p=0.02).”

They reported no statistical significant change in the incidence rate of CDI.

“This was a single center study but some of the work that is coming out—not just nationally, but internationally—seems to support that was what others saw in their institutions and large regions as well,” Patel stated.

Contagion spoke to Patel and Hawes about the study, further insights from their findings, and the importance of learning from COVID-19 and being able to apply this knowledge if need be for future pandemics.