Global incidence of Clostridioides difficile infection (CDI) in hospitals declined significantly during the COVID-19 pandemic compared with the prepandemic period, Chinese researchers reported late last week in Antimicrobial Resistance & Infection Control.

In a systematic review and meta-analysis, researchers from Hangzhou Medical College examined 16 studies on CDI incidence published from December 2019 through October 2025. Most of the studies were conducted in tertiary hospitals in high-income countries, primarily the United States and Spain. 

While several studies have investigated the pandemic’s impact on CDI, which causes severe diarrhea, the results have been inconsistent, with some studies reporting increases and others showing a marked decline. The study authors say this inconsistency reflects the “complex interplay” of multiple factors during the pandemic.

“Therefore, a comprehensive synthesis of the available evidence is needed to clarify the overall impact of the COVID-19 pandemic on the incidence of CDI,” they wrote.

20% decline in incidence

Overall, the pooled incidence rate of CDI declined from 4.42 per 10,000 patient-days before the pandemic to 3.80 per 10,000 patient-days during the pandemic, representing a 20% decline in CDI incidence (incidence rate ratio, 0.80). 

Further analysis of the studies revealed that the observed reduction in CDI incidence was influenced by the combined effects of changes in infection prevention and control, antimicrobial stewardship, and health care delivery. For example, enhanced hand hygiene, rigorous use of personal protective equipment, and increased environmental cleaning likely disrupted C difficile transmission, while reduced used of fluoroquinolones may have reduced selective pressure on certain C diff strains. Suspension of elective procedures, reduced surgical volume, and shorter hospital stays may have limited patient exposure.

The authors say these factors may have offset countervailing pandemic-related forces that exacerbated the risk of CDI and other health care-associated infections, such as increased use of broad-spectrum antibiotics, resource constraints, and diagnostic challenges.

“The net reduction in CDI incidence observed in this analysis suggests that strengthened foundational infection control practices can offset substantial systemic stressors when consistently and rigorously applied,” they wrote.

The European Commission announced today that it will invest €30 million ($34.7 million USD) in two public-private partnerships working to boost the antibiotic pipeline.

The money from the European Commission’s DG Health Emergency Preparedness and Response Authority (DG HERA) will support the work of the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) and the Global Antibiotic Research and Development Partnership (GARDP). CARB-X focuses on accelerating early-stage research and development (R&D) of novel antibiotics, diagnostics, vaccines, and preventatives, while GARDP advances late-stage antibiotic development projects.

European health officials say the aim of the funding is to ensure a comprehensive and sustainable pipeline for antimicrobial resistance (AMR) medical countermeasures in the European Union, which loses an estimated 35,000 people annually to drug-resistant infections.

“By aligning innovation from early discovery to clinical validation, we can accelerate the development of these lifesaving products and ensure their availability,” Hadja Labib, European Commissioner for Equality, Preparedness and Crisis Management, said in a CARB-X press release. “This approach tackles AMR and strengthens EU readiness for other emerging health threats, embodying our mission to build resilience and prepare for the next health crisis.”

Aligning stakeholders

The partnership will be implemented by KfW, Germany’s leading development finance bank, which will support coordination between CARB-X and GARDP. Among its tasks will be the development of an Antimicrobial Drug Pipeline Coordination Forum to “align stakeholders, maximize the impact of EU-funded AMR R&D activities, and accelerate access to medical countermeasures.”

“This partnership with DG HERA, KfW, and GARDP reflects the EU’s global leadership and reinforces the simple truth: safeguarding antimicrobial effectiveness today is essential to sustaining prosperity and security for decades to come,” said CARB-X executive director Kevin Outterson, JD.

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