Clostridioides difficile

Can treatment of COVID-19 patients with broad-spectrum antibiotics unleash multi-drug resistant bacterial pathogens?

antibiotic therapy, Clostridioides difficile, COVID-19, Enterococcus faecium, gut microbiome, Klebsiella pneumoniae, multi-drug resistance


Background: Broad-spectrum antibiotic therapy is part of the pharmacological treatment of COVID-19 patients. A potential side effect of antibiotic therapy is the loss of colonization resistance provided by a diverse and balanced gut-microbiota.

Case Presentation: A 74 year old female patient was admitted to hospital due to acute renal failure. During her stay in hospital she acquired a COVID-19 infection and was transferred to a dedicated COVID-19 clinic, where pharmaceutical therapy also comprised the administration of a broad-spectrum antibiotic (ceftriaxone). The patient suffered from diarrhea, with a negative first test for fecal Clostridioides (C.) difficile toxin. Retesting after four days confirmed a C. difficile infection (CDI) which was successfully treated with metronidazole and vancomycin. After the patient was COVID-19 symptom-free for three days she was discharged from hospital.

30 days after the discharge, the patient was re-admitted to hospital because of diarrhea and abdominal pain. Fecal C. difficile toxin was found again but this time vancomycin and metronidazole treatment failed. A stool sample was collected for culture of pathogenic bacteria, several of which (Klebsiella pneumoniae and Enterococcus faecium) were found. Despite intensive treatment, the patient’s condition gradually deteriorated and she died on day 18 of her last hospital stay due to multi-organ failure resulting from infection with pathological bacteria.

Conclusion: Awareness of the risk of antibiotic therapy of COVID-19 patients triggering proliferation of antibiotic-resistant pathogenic bacteria with potentially fatal consequences has to be increased.