The impact of the COVID-19 pandemic on hospital presentations in adults with gastrointestinal infections at a tertiary centre in Australia

Max Gottlieb; Philip Jakanovski; Sam Harding-Forrester; Alexander Mitchell; Sue Liu; Eva Zhang; Aysha Al-Ani; Jonathan Segal; Britt Christensen

doi:10.1111/imj.16597

The impact of the COVID-19 pandemic on hospital presentations in adults with gastrointestinal infections at a tertiary centre in Australia

Intern Med J. 2024 Dec 19. doi: 10.1111/imj.16597. Online ahead of print.

Authors

Affiliations

¹ Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
² Department of Anatomical Pathology, Dorevitch Pathology, Melbourne, Victoria, Australia.
³ St Vincent's Hospital, Melbourne, Victoria, Australia.
⁴ Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia.
⁵ Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.

PMID: 39698774
DOI: 10.1111/imj.16597

Abstract

Background: The COVID-19 pandemic resulted in the enactment of substantial public health measures aimed at reducing the transmission of respiratory viruses. The impact of these measures on gastrointestinal (GI) infections remains unexplored.

Aims: To determine whether there was a change in the number of patients presenting to The Royal Melbourne Hospital with GI infections during the COVID-19 pandemic compared to the year prior.

Methods: We conducted a retrospective, single-centre case-control study comparing the incidence and characteristics of hospitalisations with GI infections from March to August 2019 and across the same months in 2020, corresponding to periods immediately prior to and during the COVID pandemic.

Results: Of 430 presentations with GI infections across both time periods, there was a 51.9% decrease in hospitalisations with GI infections during the pandemic. Patients admitted during the pandemic were more likely to be admitted to the intensive care unit (0.71% vs 3.4%, P < 0.04) and to be prescribed antibiotics (21.9% vs 36.1%, P < 0.01). Length of stay and mortality were unchanged. There was a decline in the number and proportion of patients with positive faecal cultures in 2020, primarily attributed to a significant reduction in Norovirus cases (28% vs 4%) (odds ratio (OR) = 0.093, P < 0.01). Conversely, the proportion of patients presenting with Clostridioides difficile was higher in 2020 (22% vs 44%) (OR = 2.4, P = 0.01).

Conclusion: There was a substantial decrease in hospital admissions with GI infections, particularly Norovirus, during the COVID-19 pandemic. Admissions because of Clostridioides increased. Stringent public health measures reducing interpersonal contact and increased antibiotic prescribing respectively may explain these changes, while an increased reluctance to seek medical care may also have contributed to the sharp overall decrease in hospitalisations.

Keywords: COVID‐19; Clostridioides difficile; Norovirus; antibiotics; gastroenteritis; mortality.