Incidence of Hospital-Acquired Toxin-Producing Clostridioides difficile Infection Between the Pre-Pandemic (2017–2019) and Pandemic (2020–2022): A Retrospective Cohort Study (Preprint)

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BACKGROUND In 2020, the World Health Organization (WHO) declared SARS-CoV-2 a global public health emergency, driving healthcare systems worldwide to reorganize activities and adopt stringent infection prevention protocols. Among nosocomial infections, toxin-producing Clostridioides difficile infection (TCDI) remains a significant concern in hos-pitalized patients, primarily transmitted through contact. Efforts to mitigate TCDI fo-cus on minimizing in-hospital bacterial transmission, as the infection control measures implemented during the pandemic. OBJECTIVE Objective: to evaluate the incidence of nosocomial TCDI during the pandemic, compar-ing the impact of non-pharmacological measures implemented during this period with prior years and identify associations between risk factors in these periods. METHODS A retrospective observational cohort study was conducted at A Coruña University Hos-pital from 2017 to 2022. Patients were categorized into pre-pandemic (2017-2019) or pandemic (2020-2022) groups based on nosocomial TCDI criteria. Descriptive analyses evaluated age, sex, antibiotic use, and comorbidities. Incidence rates were calculated, and risk factor associations were analyzed for both periods. RESULTS The study identified 249 nosocomial TCDI cases: 89 pre-pandemic and 160 during the pandemic, reflecting a 79.8% increase. Patients hospitalized during the pandemic faced a 92% greater risk of TCDI (RR=1.92, p=0.001). The incidence density of TCDI during the pandemic years was 1.44 CDI/10,000 patient-days Predisposing factors in-cluded solid organ neoplasms (pre-pandemic 33.7%; pandemic 33.1%), secondary im-munosuppression (pre-pandemic 31.5%; pandemic 40.6%). CONCLUSIONS In conclusion, despite implementing precautionary measures, nosocomial TCDI inci-dence increased during the pandemic. Understanding the factors contributing to TCDI acquisition in hospitalized patients is crucial for designing effective preventive inter-ventions and strategies CLINICALTRIAL not a clinical trial