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A study by Centers for Disease Control and Prevention researchers found that, despite changes in infection control practices, antibiotic use, and healthcare delivery during the first year of the COVID-19 pandemic, Clostridioides difficile infection rates did not change. The findings were published yesterday in Infection Control & Hospital Epidemiology.

Using adult and pediatric inpatient records from 775 hospitals in the Premier Healthcare Database, the researchers estimated monthly incidence rates of hospital-onset C difficile (HO-CDI) per 10,000 patient-days (PD), community-onset CDI (CO-CDI) per 10,000 discharges, and C difficile testing rates per 10,000 discharges from January 2019 through December 2020, comparing monthly differences of the rates between years. They used an interrupted time series (ITS) design to describe level and trend changes in rates and percent positivity before and after the pandemic began on March 2020.

During the study period, 47,658 inpatients were diagnosed as having CDI, with CO-CDI representing 55% of all incident cases. In pairwise comparisons, overall CO-CDI rates decreased from 20.0 to 15.8 cases per 10,000 discharges from 2019 to 2020, but rates of HO-CDI per 10,000 PD were similar (3.3 in 2019 and 3.2 in 2020).

Using ITS, the researchers detected decreasing monthly trends in CO-CDI (−1% per month, P = .0036) and HO-CDI incidence (−1% per month, P < .0001) during the baseline period, prior to the COVID-19 pandemic declaration. But they detected no change in monthly trends for CO-CDI or HO-CDI incidence or percent positivity after March 2020 compared with the baseline period.

"Given the significant morbidity and mortality associated with CDI and the burden in US hospitals, ongoing monitoring of the trends in CDI as healthcare delivery returns to prepandemic levels is important to inform hospital antibiotic stewardship and infection control programs," the study authors concluded. May 19 Infect Control Hosp Epidemiol abstract

A survey of healthcare providers at student health centers on US college campuses found that they frequently feel pressure for antibiotics from patients with upper respiratory tract infections (URTIs), researchers reported today in the American Journal of Infection Control.

In the survey, which was completed by 103 student health center physicians and nurse practitioners who reported seeing an average of 43.9 URTI patients per week during cold and flu season, respondents reported that they perceived patients to want antibiotics in roughly 50% of visits.

The most frequently reported driver of desire for antibiotics were recovery from illness, past prescribing of antibiotics, patient misconceptions or misinformation, and social network influence. Discussion of antibiotics with patients, the providers reported, created an uncomfortable interaction in 21% of visits.

Patients' most common pressure tactic for getting antibiotics were reporting that they had received antibiotics for a prior infection (50%), emphasizing symptoms to imply a need for antibiotics (48%), suggesting a diagnosis (44%), and simply requesting antibiotics (35%). Respondents stated that the greatest discomfort arose when patients reported receiving antibiotics for a prior infection.

In visits where the provider perceived patient pressure for antibiotics for a URTI, the most frequent response was to explain the disease or diagnosis (56.3%), explain antibiotic utility and risk (51.5%), explain the treatment plan (46.6%), and explain antibiotic resistance (36.9%).

"While it remains possible that providers sometimes perceive more pressure than patients intend, the current study provides evidence regarding the diversity and ubiquity of patient influence tactics, indicating that patient expectation for antibiotics is a reality underlying many URTI visits," the study authors wrote.

"Faced with these and other influence efforts, providers need communication strategies that enable them to simultaneously withstand pressure, respond professionally and compassionately to maintain satisfaction with care, and educate patients in ways that reduce future efforts to obtain unnecessary antibiotics." May 20 Am J Infect Control abstract

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