Secondary Logo

Journal Logo


S0164 Clostridioides difficile Infection in COVID-19 Patients

Allegretti, Jessica R. MD, MPH1; Njie, Cheikh MD1; McClure, Emma1; Redd, Walker D. MD1; Wong, Danny MD1; Zhou, Joyce C. BA2; Bazarbashi, Ahmad Najdat MD3; McCarty, Thomas R. MD1; Hathorn, Kelly E. MD1; Shen, Lin MD1; Jajoo, Kunal MD1; Chan, Walter W. MD, MPH1

Author Information
The American Journal of Gastroenterology: October 2020 - Volume 115 - Issue - p S68
doi: 10.14309/01.ajg.0000702704.93673.65
  • Free


Gastrointestinal manifestations including diarrhea are prevalent among COVID-19 patients. Given the frequent use of broad-spectrum antibiotics, COVID-19 patients are also at substantial risk for hospital-acquired diarrheal illnesses. We aimed to evaluate the prevalence and outcomes of Clostridioides difficile infection (CDI) among hospitalized patients with COVID-19.


This was a retrospective cohort study of patients hospitalized with laboratory confirmed COVID-19 across 9 hospitals in Massachusetts in 3/11/2020–4/2/2020. All patients underwent stool testing for CDI with glutamate dehydrogenase (GDH) and ELISA immunoassay (EIA) for toxin. Inconclusive GDH/EIA with high clinical suspicion were confirmed with polymerase chain reaction (PCR). Positive CDI rate in COVID-19 patients was compared with local historical inpatient CDI testing data from 2019. Outcomes and mortality were also compared amongst COVID-19 patients with and without CDI.


Of the 390 hospitalized patients with COVID-19, 97 (24.9%) were tested for CDI and included in the study. All patients received ≥2 antibiotics (median = 4, IQR 2–5.5). Compared to historical controls, COVID-19 patients did not have higher overall CDI positive rate (5.2% [n = 5] vs 9.8% [n = 280]; P = 0.16). Specifically, GDH/EIA positive rates were similar between both groups (5.2% vs 5.3%). There were no statistically significant differences in median antibiotic use, PPI use, laboratory data or need for ICU care between CDI vs non-CDI patients. However, all-cause mortality was significantly higher among CDI patients (80% vs 12.2%; P < 0.0001) Table 1.


The prevalence of CDI was not higher among COVID-19 patients despite widespread use of broad-spectrum antibiotics. With strict isolation of COVID-19 patients in most hospitals, together with aggressive hand washing and donning/doffing protocols, it is possible that such rigorous measures resulted in the unintended benefit of reducing nosocomial CDI. However, albeit a limited sample size, development of CDI was associated with significantly worse outcomes and higher mortality. As such, early CDI testing should be implemented among patients with COVID-19 to ensure prompt diagnosis and management.

Table 1.:
(A) Clostridioides difficile infection stool testing of COVID-19 patients compared to all inpatient CDI tests in 2019. (B) Hospitalization course and outcomes of COVID-19 patients with and without CDI. * Stool PCR only performed with GDH/EIA indeterminant samples
© 2020 by The American College of Gastroenterology