key: cord-0935979-4cyyrq5e authors: Spigaglia, Patrizia title: COVID-19 and Clostridioides difficile infection (CDI): Possible implications for elderly patients date: 2020-06-25 journal: Anaerobe DOI: 10.1016/j.anaerobe.2020.102233 sha: 54afbceaf64d381cce1855c90ce9a526e8d25a81 doc_id: 935979 cord_uid: 4cyyrq5e COVID-19 dramatically affects the elderly. Due to the large usage of antibiotics during the current pandemic and the gastrointestinal manifestations of COVID-19, the elderly population, hospitalized patients, residents in LTCFs and persons that survived the COVID-19 might be more prone to Clostridioides difficile infections (CDI). A renewed attention to CDI is necessary during the ongoing COVID-19 pandemic. The novel coronavirus disease , caused by the Severe Acute Respiratory Syndrome 25 Coronavirus-2 (SARS-CoV-2), also known as the 2019 novel coronavirus (2019-nCoV), has 26 emerged in Wuhan (China) in early December 2019 and it has rapidly spread worldwide causing a 27 major pandemic [1] . 28 Frail individuals with underlying diseases and chronic conditions are the most vulnerable to 29 COVID-19 infections. In particular, the elderly are highly affected by COVID-19 compared to 30 young and middle-aged people, both in terms of prevalence of the disease and mortality [2, 3, 4] . In 31 China, where the elderly represent a small proportion of the total population, patients >60 years or 32 older affected by COVID-19 were reported to be between 15% and 26%, with a mortality rate 33 which was significantly higher compared to younger patients (5. 3.60/10,000 patient-days during January-April 2020. All these data indicate that antimicrobial stewardship programs for the appropriate and responsible A Novel Coronavirus from Patients 151 with Pneumonia in China Clinical features of deaths in the novel coronavirus epidemic in China Clinical characteristics of 155 140 patients infected by SARS-CoV-2 in Wuhan, China Covid-19 may worsen the antibiotic resistance crisis-WIRED Collateral damage: Coronavirus poses major challenge for scientific Infectious diseases 205 in older adults of long-term care facilities: update on approach to diagnosis and 206 management Centers for Disease Control & Prevention. Antibiotic Resistance Threats in the United 208 U.S. Department of Health and Human Services Clostridium difficile infection in the United States The need for European Surveillance of CDI Antibiotic-associated diarrhea Clostridium difficile infection in the elderly The 221 attributable burden of Clostridium difficile infection to long-term care facilities stay: a 222 clinical study European long-term care facilities: results from the third point prevalence survey of 227 healthcare-associated infections and antimicrobial use Clostridioides 230 difficile in COVID-19 patients Clostridium difficile infections Colonization resistance of the gut 251 microbiota against Clostridium difficile • A renewed attention to CDI is crucial in Covid-19 era • COVID-19 dramatically affects the elderly population • Large antibiotics usage during the pandemic might lead to an increment of CDI• Hospitalized elderly and LTCFs residents might be at high risk of CDI• Elderly patients that survive COVID-19 could be also at risk of CDI ☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: