Study Reveals How COVID-19 Reshaped C. Difficile Infection Risks
Nikhil Prasad Fact checked by:Thailand Medical News Team Aug 19, 2026 1 hour, 2 minutes ago
A new study has revealed how the COVID-19 pandemic may have reshaped the circumstances surrounding Clostridioides difficile infection (CDI), a potentially dangerous intestinal infection commonly affecting hospitalized patients.
Researchers found that COVID-19 reshaped medication exposures and infection patterns surrounding C. difficile,
without independently increasing 90-day mortality.
Importantly, researchers found that previous or concurrent COVID-19 did not independently increase the risk of death within 90 days of CDI diagnosis.
Researchers Studied Hundreds of Hospitalized Patients
Researchers retrospectively examined 324 adults diagnosed with CDI between 2020 and 2022 at Louis Pasteur University Hospital in Košice, Slovakia. The patients had a median age of 72 years, while 71.3 percent were aged 65 or older. Most infections—79.3 percent—were hospital-acquired.
The researchers were from the Department of Infectology and Travel Medicine, Department of Medical and Clinical Microbiology, and Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Slovakia.
For the main comparison, 144 patients had previous or concurrent COVID-19, defined as infection within three months before or at CDI diagnosis, while 172 had no COVID-19 history.
COVID-19 Group Had a Different Medication Risk Profile
One of the clearest findings involved medications known to influence CDI risk. Patients with previous or concurrent COVID-19 had substantially greater exposure to corticosteroids, at 70.1 percent compared with 26.2 percent among patients without COVID-19.
Proton pump inhibitors, medicines that reduce stomach acid, were also more common, affecting 88.2 percent versus 73.3 percent.
As this Thailand
Medical News report highlights, antibiotic exposure itself was extremely common in both groups, affecting approximately 94 percent of patients. However, important differences emerged in the specific antibiotics used.
Cephalosporins had been given to 72.9 percent of COVID-19-associated patients versus 61.6 percent without COVID-19. Macrolide exposure showed an even larger difference, at 37.5 percent versus 20.3 percent.
Recurrent Infections Require Careful Interpretation
CDI recurrence occurred in 18.1 percent of patients with previous or concurrent COVID-19 compared with 9.9 percent without COVID-19.
However, this finding requires caution. After researchers adjusted for age, sex and exposure to proton pump inhibitors, corticosteroids, cephalosporins and macrolides, COVID-19 was no longer significantly associated with recurrence. This indicates that medication exposure and other patient characteristics may partly explain the higher observed recurrence rate rather than COVID-19 itself.
A Dominant Bacterial Strain Emerged
Researche
rs successfully ribotyped 274 bacterial isolates. RT176 dominated, accounting for 62.8 percent, followed by RT001 at 17.5 percent and RT027 at 6.9 percent.
RT176 was particularly concerning because it showed significantly greater resistance to rifaximin, rifampicin and tetracycline compared with other ribotypes. Researchers suggested that antimicrobial pressure within hospitals could contribute to the persistence and spread of such epidemic strains.
COVID-19 Did Not Increase 90-Day Death Risk
Ninety-day mortality was 42.4 percent among patients with previous or concurrent COVID-19 and 43.6 percent among those without COVID-19—a statistically insignificant difference.
Instead, mortality was more closely associated with older age and signs of severe illness, including higher inflammatory markers, white blood cells, neutrophils, creatinine and IL-6, together with lower lymphocyte, eosinophil and albumin levels.
Conclusions
The findings indicate that COVID-19 primarily reshaped the medication exposures, risk factors and bacterial patterns surrounding CDI rather than independently worsening short-term survival. The higher unadjusted recurrence rate deserves attention, but the analysis suggests medications, patient characteristics and pandemic-related hospital changes could have contributed substantially to this difference.
The study findings were published in the peer reviewed journal: Antibiotics.
https://www.mdpi.com/2079-6382/15/8/806
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https://www.thailandmedical.news/articles/coronavirus
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