Infekcija Clostridioides difficile u COVID-19 bolesnika - iskustva iz KBC Rijeka

professional thesis

• Title (english): Clostridioides difficile infections in COVID-19 patients – Clinical Hospital Center Rijeka experience
• Author: Samira Knežević
• Mentor: Ana Budimir (mentor)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2024-01-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Infectology

Abstract

Gastrointestinalne manifestacije (mučnina, povraćanje, proljev) najčešće su izvanplućne manifestacije infekcije COVID-19. Iako proljev može biti jedan od simptoma COVID-19 infekcije, koinfekcija COVID-19 i Clostridioides difficile (CD) najčešći je uzrok proljeva kod COVID-19 pacijenata koji primaju antibiotike širokog spektra. Najveći rizik predstavljaju bolesnici starije dobi s anamnezom nedavne hospitalizacije. Pravovremena dijagnoza i liječenje od osobite je važnosti da bi se izbjegle komplikacije i nepovoljan ishod bolesti.
Cilj ovog istraživanja bio je procijeniti incidenciju CDI kod pacijenata hospitaliziranih zbog COVID-19, kao i utjecaj koinfekcije na dužinu hospitalizacije i ishod COVID-19.
Provedena je retrospektivna analiza jednog centra, Kliničkog bolničkog centra (KBC) Rijeka koja je uključila 46 bolesnika starijih od 18 godina s COVID-19/CD koinfekcijom liječenih u COVID jedinicama KBC Rijeka u periodu od 25.02.2020.-31.12.2021. U studiju nisu uključeni bolesnici kod kojih su simptomi CDI počeli nakon otpusta iz bolnice (u post-COVID periodu).
Incidencija CDI među hospitaliziranim bolesnicima s COVID-19 bila je 4,1 puta veća u odnosu na incidenciju CDI ne-COVID-19 bolesnika u KBC-u Rijeka u istom periodu. Većina bolesnika bila je starije životne dobi (76 % starije od 65 godina). Kod 50 % bolesnika postojao je podatak o recentnoj (unutar 60 dana) hospitalizaciji. Gotovo svi pacijenti (97 %) primali su antimikrobnu terapiju tijeku liječenja COVID-19. Duljina hospitalizacije u bolesnika s koinfekcijom bila je 2,6 puta veća u odnosu na s COVID-19 bolesnike koji nisu imali CDI (25 : 9,5 dana). Smrtnost bolesnika s koinfekcijom iznosila je 28,26 %. Bolesnici starije životne dobi s COVID-19 infekcijom koji primaju antibiotike širokog spektra i koji su nedavno liječeni u bolnici predstavljaju rizičnu skupinu za razvoj CDI. COVID-19 može maskirati početak i nepovoljno utjecati na klinički tijek CDI, istovremeno CDI može pogoršati tijek i kao i prognozu COVID-19.

Abstract (english)

Gastrointestinal manifestations (nausea, vomiting, diarrhoea) are the most common extrapulmonary manifestations of COVID-19 infection. Although diarrhoea may be one of the symptoms of COVID-19 infection, COVID-19 and Clostridioides difficile (CD) coinfection is the most common cause of diarrhoea in patients receiving broad-spectrum antibiotic treatment. Elderly patients who have recently been admitted to the hospital are particularly at risk for a coinfection, as was the case with Clostridioides difficile infection (CDI). Delaying an early diagnosis and course of treatment for these patients can have fatal consequences.
The aim of this study was to evaluate the incidence of CDI in patients hospitalized for COVID-19 as well as the influence of the coinfection on the duration of the hospitalization and the COVID-19 outcome.
In a retrospective study carried out from 25th February 2020 to 31st December 2021, medical histories of 46 patients with COVID-19/CD coinfection treated in the COVID department of Clinical Hospital Center Rijeka were analysed. Patients whose CDI symptoms started after hospital discharge (post-COVID period) were excluded from the research.
The incidence of CDI among COVID-19 hospitalized patients was 4,1 times greater compared to the incidence of CDI in the total number of non-COVID-19 patients in the Clinical Hospital Center Rijeka during the same period. Most of the patients were elderly (76% older than 65 years of age). Recent hospitalization (within 60 days) was present in 50% of patients. Nearly all patients (97%) were receiving antimicrobial therapy during COVID-19 infection. The length of hospitalization in patients with coinfection was 2,6 times longer compared to COVID-19 patients who did not have CDI (25 : 9,5 days). The lethal outcome was present in 28,26% of the cases.
Elderly patients with empirical antibiotic therapy, and those who have been hospitalized recently, are among the COVID-19 patients who are more likely to develop CDI. The onset and clinical course of CDI can be affected by COVID-19 infection, while CDI can also worsen the course and prognosis of COVID-19 infection.

• Keywords: COVID-19; Clostridioides difficile; koinfekcija; rizični faktori
• Keywords (english): COVID-19; Clostridioides difficile; coinfection; risk factors
• Language: croatian
• URN:NBN: urn:nbn:hr:105:483471
• Study programme: Title: Infectious diseases; Study programme type: university; Study level: postgraduate specialist; Academic / professional title: sveučilišni/a magistar/magistra infektologije (sveučilišni/a magistar/magistra infektologije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-02-16 09:02:38