P1617 - The Incidence and Severity of Inpatient Hospital Admissions for Concomitant COVID-19 and Clostridioides difficile Infection

Megan B. Ghai, MD, MPH, MA¹, Pooja Rangan, MBBS, MPH¹, Wahid Wassef, MD, MPH, FACG^2
1University of Arizona College of Medicine, Phoenix, AZ; ²Banner University Medical Center, Phoenix, AZ

Introduction: More than 10% of those with COVID-19 experienced diarrhea. While it is hypothesized that COVID-19 causes cell-mediated changes in the intestine leading to diarrhea, co-infections with Clostridioides difficile have also been reported. Here we compare the incidence and severity of hospitalizations for Clostridioides difficile infection (CDI) in those with and without a concomitant diagnosis of COVID-19.

Methods: A retrospective analysis of U.S. inpatient discharges from 2020 using the Healthcare Cost and Utilization Project National Inpatient Sample was performed. Included were adult CDI discharges, as defined by ICD-10-CM codes. Weights were used to generate nationally representative estimates. Descriptive statistics were produced using Pearson’s chi-squared tests. Severity was evaluated, as defined by mean length of stay (LOS), mortality, and complication rates. Multivariate logistic regression was used to evaluate the independent association of COVID-19 and death within the CDI population.

Results: Included were 215,480 weighted inpatient discharges for CDI, 4.97% of which had a concomitant diagnosis of COVID-19 (Table 1). Race varied significantly between those with and without COVID-19, particularly among White (73.9% vs 59.5%), Black (13.1% vs 20.7%), and Hispanic races (7.9% vs 13.5%) [X²(5, N=210,685)= 223.5, p < 0.001]. LOS comparatively increased in the COVID-19 group (+5.07 days, p < 0.001). Rates of acute kidney failure, sepsis, and respiratory failure were all significantly higher in the CDI group. Death rate was higher in the COVID-19 group (without COVID= 6.05% vs COVID= 23.0%) [X²(1, N=215,424)= 912.35, p < 0.001]. The adjusted odds of death in the COVID-19 group was more than three times greater than that of the group without COVID-19 (OR=3.11, 95% CI [2.39, 4.04], p < 0.001) after adjusting for age, race, sex, BMI, complications of CDI, and risk factors for developing worsening COVID-19.

Discussion: In those hospitalized with CDI, hospitalization severity and risk of death was higher in those with concomitant COVID-19. These results suggest that primary prevention of COVID-19 is essential in those who are at high risk of CDI. CDI and COVID-19 should be aggressively treated in those with co-infection. Oral vancomycin prophylaxis may be considered to prevent CDI in those hospitalized with COVID-19. Finally, hospitals must enforce stringent infection control measures to prevent the spread of CDI and COVID-19.


Disclosures:


Megan B. Ghai, MD, MPH, MA¹, Pooja Rangan, MBBS, MPH¹, Wahid Wassef, MD, MPH, FACG². P1617 - The Incidence and Severity of Inpatient Hospital Admissions for Concomitant COVID-19 and Clostridioides difficile Infection, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.