Sharp Rise in C Difficile Cases Found in Greece During COVID-19 Pandemic


The interrupted time-series resulted in an increase in C. difficile infection incidences during the pre-pandemic period from 0.00 to 3.36 infections per 10,000 bed days during the COVID-19 pandemic.

Sharp Rise in C Difficile Cases Found in Greece During COVID-19 Pandemic

Theodoros Karampatakis, MD, MSc, PhD, FRSPH

Credit: Linkedin

A new analysis based in Greece showed Clostridioides difficile infections (CDI) increased in a hospital-setting during the recent COVID-19 pandemic in comparison to the what was found at the same hospital prior to the pandemic.

A team, led by Theodoros Karampatakis, MD, MSc, PhD, FRSPH, ​Microbiology Department, Papanikolaou General Hospital, assessed the impact of the COVID-19 pandemic on the incidence rate of CDI in a Greek hospital.

“C. difficile infection represents an important global threat,” the authors wrote. “In the COVID-19 era, the multifactorial nature of CDI has emerged.”

A Recent Problem

In recent years, the spread of hypervirulent strains have increased the severity of CDI cases.

In addition, there is a lot of concern over the impact of the COVID-19 pandemic on CDI, mainly due to the excessive use of broad-spectrum antimicrobials, poor implementation of infection control measures, and prolonged hospitalizations for elderly patients.

“Although the full impact of the COVID-19 pandemic on CDI remains undetermined, it is important to consider that the COVID-19 pandemic may complicate CDI diagnosis,” the authors wrote. “A great concern has arisen from the decrease in C. difficile testing and the increased use of broad-spectrum antibiotics reported during the pandemic.”

The Location

In the retrospective study, the investigators examined data between January 2018 and March 2022, breaking the study into a pre-pandemic period between January 2018 and February 2020 and the COVID-19 pandemic period between March 2020 and March 2022.

The team collected stool samples from 4335 patients with diarrhea during the 51 month study period, 1688 during the pre-pandemic period and 2647 during the COVID-19 pandemic period.

Of the stool samples tested, 82.6% (n = 3581) were negative, 8.7% (n = 377) were only positive for GDH, and 8.7% (n = 377) were positive for both GDH and Toxin A/B.

The investigators applied various infection control measures, including hand hygiene, contact precautions for patients with CDI and/or COVID-19 infections, patient and staff cohorting, and environmental cleaning. These practices were conducted along with antimicrobial prescription policies that remained unchanged throughout the duration of the entire study period.

The study took place at the Papanikolaou General Hospital of Thessaloniki, a 638-bed hospital with 13 internal medicine departments, 9 surgical wards, 2 hematology departments, and 2 psychiatric departments, as well as 3 intensive care units and 4 high dependency units.

The team compared the effects of the pandemic to the pre-pandemic period on the incidence of CDI using a time-series analysis.

The Data

The results show an increase in the monthly CDI incidence from 0.00 to 11.77 infections per 10,000 bed days (P <0.001).

The interrupted time-series resulted in an increase in CDI incidence during the pre-pandemic period from 0.00 to 3.36 infections per 10,000 bed day (P <0.001). During the pandemic, the linear trend for monthly CDI increased from 2.65 to 13.93 infections per 10,000 bed days.

The overall increase rate was higher during the pandemic (r2 = +0.47) compared to the pre-pandemic period (r1 = +0.16).

“A significant increase of CDI incidence was observed, with the rate of the rise being more intense during the COVID-19 pandemic,” the authors wrote.


Karampatakis, T., Tsergouli, K., Kandilioti, E., Nikopoulou, A., Katsifa, H., & Kachrimanidou, M. (2023). Implication of COVID-19 pandemic on the incidence of clostridioides difficile infection in a greek tertiary hospital. Journal of Medical Microbiology, 72(5).

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