{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:55:01Z","timestamp":1787025301521,"version":"build-2736575974"},"reference-count":14,"publisher":"Walter de Gruyter GmbH","issue":"4","license":[{"start":{"date-parts":[[2021,11,20]],"date-time":"2021-11-20T00:00:00Z","timestamp":1637366400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Introduction.<\/jats:bold>\n                    Information on healthcare-associated\n                    <jats:italic>C.difficile<\/jats:italic>\n                    infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods.<\/jats:bold>\n                    We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017\u20132018.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results.<\/jats:bold>\n                    We found 51 cases during 2020\u20132021 (COVID-19 group), incidence 5.6\/1000 adult discharge and 99 cases during 2017\u20132018 (pre-COVID-19 group), incidence 6.1\/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days).\n                  <\/jats:p>\n                  <jats:p>Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment \u2013 mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions.<\/jats:bold>\n                    The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017\u20132018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19.\n                  <\/jats:p>","DOI":"10.2478\/rjim-2021-0020","type":"journal-article","created":{"date-parts":[[2021,5,30]],"date-time":"2021-05-30T18:53:22Z","timestamp":1622400802000},"page":"409-415","source":"Crossref","is-referenced-by-count":6,"title":["Healthcare-associated\n                    <i>Clostridioides difficile<\/i>\n                    infection during the COVID-19 pandemic in a tertiary care hospital in Romania"],"prefix":"10.2478","volume":"59","author":[{"given":"Eliza","family":"Manea","sequence":"first","affiliation":[{"name":"\u201cProf. Dr. Matei Bals\u201dNational Institute for Infectious Diseases , Bucharest , Romania"},{"name":"\u201cCarol Davila\u201d University of Medicine and Pharmacy , Bucharest , Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca","family":"Jipa","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. Matei Bals\u201dNational Institute for Infectious Diseases , Bucharest , Romania"},{"name":"\u201cCarol Davila\u201d University of Medicine and Pharmacy , Bucharest , Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Milea","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. Matei Bals\u201dNational Institute for Infectious Diseases , Bucharest , Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Roman","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. Matei Bals\u201dNational Institute for Infectious Diseases , Bucharest , Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgiana","family":"Neagu","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. Matei Bals\u201dNational Institute for Infectious Diseases , Bucharest , Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Hristea","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. Matei Bals\u201dNational Institute for Infectious Diseases , Bucharest , Romania"},{"name":"\u201cCarol Davila\u201d University of Medicine and Pharmacy , Bucharest , Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2021,11,20]]},"reference":[{"key":"2026042913132715591_j_rjim-2021-0020_ref_001","doi-asserted-by":"crossref","unstructured":"1. REDD WD, ZHOU JC, HATHORN KE, MCCARTY TR, BAZARBASHI AN, THOMPSON CC, et al. Prevalence and characteristics of gastrointestinal symptoms in patients with SARS-CoV-2 infection in the United States: A multicenter cohort study. Gastroenterology. 2020; 159(2): 765\u20137.10.1053\/j.gastro.2020.04.045","DOI":"10.1053\/j.gastro.2020.04.045"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_002","doi-asserted-by":"crossref","unstructured":"2. HAQUE M, SARTELLI M, MCKIMM J, ABU BAKAR M. Health care-associated infections \u2013 an overview. Infection and Drug Resistance. 2018;11:2321\u201333.10.2147\/IDR.S177247","DOI":"10.2147\/IDR.S177247"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_003","doi-asserted-by":"crossref","unstructured":"3. BENTIVEGNA E, ALESSIO G, SPUNTARELLI V, LUCIANI M, SANTINO I, SIMMACO M, et al. Impact of COVID-19 prevention measures on risk of health care-associated Clostridium difficile infection. American Journal of Infection Control. 2020;1\u20133.10.1016\/j.ajic.2020.09.010","DOI":"10.1016\/j.ajic.2020.09.010"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_004","doi-asserted-by":"crossref","unstructured":"4. ESNAL DE, ONTIYUELO CM, ROUCO MEN, CUSCO MA, FERRANDEZ M, HORCAJADA JP, et al. Azithromycin in the treatment of COVID-19: a review. Expert Review of Anti-infective Therapy. 2020;19(2):147\u201363.10.1080\/14787210.2020.1813024","DOI":"10.1080\/14787210.2020.1813024"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_005","doi-asserted-by":"crossref","unstructured":"5. FERREIRA EO, PENNA B, YATES EA. Should we be worried about Clostridioides difficile during the SARS-CoV2 pandemic? Frontiers in Microbiology. 2020;11.10.3389\/fmicb.2020.581343","DOI":"10.3389\/fmicb.2020.581343"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_006","doi-asserted-by":"crossref","unstructured":"6. BIGNARDI GE. Risk factors for Clostridium difficile infection. Journal of Hospital Infections. 1998;40:1\u201315.10.1016\/S0195-6701(98)90019-6","DOI":"10.1016\/S0195-6701(98)90019-6"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_007","doi-asserted-by":"crossref","unstructured":"7. CALU V, TOMA EA, ENCIU O, MIRON A. Clostridium difficile infection and colorectal surgery: is there any risk? Medicina. 2019;55:683.","DOI":"10.3390\/medicina55100683"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_008","doi-asserted-by":"crossref","unstructured":"8. RAWSON TM, MOORE LSP, ZHU N, RANGANATHAN N, SKOLIMOWSKA K, GILCHRIST M, et al. Bacterial and fungal co-infection in individuals with coronavirus: A rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020;3;71(9):2459\u201368.10.1093\/cid\/ciaa530719759632358954","DOI":"10.1093\/cid\/ciaa530"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_009","doi-asserted-by":"crossref","unstructured":"9. CROBACH MJT, PLANCHE T, ECKERT C, BARBUT F, TERVEER EM, DEKKERS OM, et al. European Society of Clinical Microbiology and infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2016;22(s4):s63-s81.10.1016\/j.cmi.2016.03.01027460910","DOI":"10.1016\/j.cmi.2016.03.010"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_010","unstructured":"10. European Centre for Disease Prevention and Control. European Surveillance of Clostridium difficile infections. Surveillance protocol version 2.2. Stockholm: ECDC. 2015."},{"key":"2026042913132715591_j_rjim-2021-0020_ref_011","doi-asserted-by":"crossref","unstructured":"11. MCDONALD LC, GERDING DN, JOHNSON S, BAKKEN JS, CARROLL KC, COFFIN SE, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). CID. 2018;66(7):e1\u2013e48.10.1093\/cid\/cix1085601898329462280","DOI":"10.1093\/cid\/cix1085"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_012","doi-asserted-by":"crossref","unstructured":"12. GRANATA G, BARTOLONI A, CODELUPPI M, CONTADINI I, CRISTINI F, FANTONI M, et al. The burden of Clostridioides diffcile infection during the COVID-19 Pandemic: A Retrospective Case-Control Study in Italian Hospitals (CloVid). J. Clin. Med. 2020; 9:3855.","DOI":"10.3390\/jcm9123855"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_013","doi-asserted-by":"crossref","unstructured":"13. SANDHU A, TILLOTSON G, POLISTICO J, SALIMNIA H, CRANIS M, MOSHOS J, et al. Clostridiodes difficile in COVID-19 Patients, Detroit, Michigan, USA, March\u2013April 2020. Emerging Infectious Diseases. 2020; 26:9.10.3201\/eid2609.202126745407532441243","DOI":"10.3201\/eid2609.202126"},{"key":"2026042913132715591_j_rjim-2021-0020_ref_014","doi-asserted-by":"crossref","unstructured":"14. LANGFORD BJ, SO M, RAYBARDHAN S, LEUNG V, WESTWOOD D, MACFADDEN DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020; 26:1622\u20139.10.1016\/j.cmi.2020.07.016783207932711058","DOI":"10.1016\/j.cmi.2020.07.016"}],"container-title":["Romanian Journal of Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/reference-global.com\/pdf\/10.2478\/rjim-2021-0020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T17:59:04Z","timestamp":1777485544000},"score":1,"resource":{"primary":{"URL":"https:\/\/reference-global.com\/article\/10.2478\/rjim-2021-0020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,20]]},"references-count":14,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,11,20]]},"published-print":{"date-parts":[[2021,12,1]]}},"alternative-id":["10.2478\/rjim-2021-0020"],"URL":"https:\/\/doi.org\/10.2478\/rjim-2021-0020","relation":{},"ISSN":["2501-062X"],"issn-type":[{"value":"2501-062X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,20]]}}}