Kanika Sehgal - Academia.edu (original) (raw)
Papers by Kanika Sehgal
Clinical Gastroenterology and Hepatology
Therapeutic Advances in Gastroenterology
Background: Microscopic colitis (MC) causes chronic diarrhea. It has two histologic subtypes: lym... more Background: Microscopic colitis (MC) causes chronic diarrhea. It has two histologic subtypes: lymphocytic colitis (LC) and collagenous colitis (CC). Little is known about the natural progression of disease with time and with treatment. Objectives: We aimed to assess histological changes over time. Design: We designed a retrospective study including adults diagnosed with MC from January 1992 to January 2020 at Mayo Clinic. Methods: Pathology reports were reviewed until 31 October 2020. Histological assessments at least 8 weeks apart were considered as adequate follow-up. Histological change from one subtype to the other and resolution were tracked with univariate and multivariable Cox proportional hazards models. Results: Overall, 416 patients with a median age at diagnosis of 63.9 years with >1 histopathological assessment were identified. Histology at initial diagnosis was CC in 218 (52.4%) patients and LC in 198 (47.6%). No medications were associated with a histological change...
American Journal of Gastroenterology
American Journal of Gastroenterology
American Journal of Gastroenterology
American Journal of Gastroenterology
INTRODUCTION Outcomes and safety of budesonide maintenance therapy in microscopic colitis (MC) ar... more INTRODUCTION Outcomes and safety of budesonide maintenance therapy in microscopic colitis (MC) are not well known. METHODS Adult residents of Olmsted County, Minnesota diagnosed with MC (2002-2019) and treated with budesonide were identified using the Rochester Epidemiology Project. Response was assessed at 12 +/- 4 weeks after initiation of therapy and defined as complete (resolution of diarrhea), partial (≥50% improvement in number of bowel movements), nonresponse (<50% improvement), and intolerance (discontinued due to side-effects). For safety outcomes, cases (budesonide maintenance) and MC controls (no budesonide therapy) were matched by gender and age at diagnosis (+/-2 years). RESULTS A total of 450 patients were identified, of which 162 (36.0%) were treated with budesonide for induction of clinical remission [median age 67 (23-91) years and 126 (77.8%) female]. Clinical outcomes for induction were as follows: 130 (80.2%) complete response, 22 (13.6%) partial response, 8 (4.9%) no response, and 2 (1.2%) intolerance. After induction, 96 (63.2%) had recurrence after discontinuation; 27 (28.1%) required further budesonide induction treatment without maintenance, 56 (58.3%) required long-term budesonide maintenance, and 13 (13.5%) were treated with other therapies. Of those receiving budesonide maintenance, all responded [55 (98.2%) complete, 1 (1.8%) partial]. No patient stopped maintenance from adverse events. The median duration of follow-up was 5.6 years (0.3-18.9). There was no significant difference between cases and controls in the incidence of osteopenia/ osteoporosis, diabetes mellitus, hypertension, glaucoma, or cataracts. CONCLUSION The long-term use of budesonide in MC appears to be effective and generally well tolerated with limited adverse effects.
Therapeutic Advances in Gastroenterology, 2021
The pathogenesis of Clostridioides difficile infection (CDI) has largely been attributed to the a... more The pathogenesis of Clostridioides difficile infection (CDI) has largely been attributed to the action of two major toxins – A and B. An enhanced systemic humoral immune response against these toxins has been shown to be protective against recurrent CDI. Over the years, fully human monoclonal antibodies against both of these toxins have been developed in an attempt to counter the increasing incidence of recurrent CDI. Clinical trials conducted to evaluate the efficacy of anti-toxin A monoclonal antibody, actoxumab, and anti-toxin B monoclonal antibody, bezlotoxumab, demonstrated that bezlotoxumab substantially lowered the rate of recurrent infection, while actoxumab did not. A significant therapeutic benefit was appreciated in patients with at least one high-risk factor for recurrence, including, age ⩾65 years, immunocompromised state, prior CDI and severe CDI. In light of toxins A and B being immunogenic, vaccine trials are underway with the aim to prevent primary infection.
Therapeutic Advances in Gastroenterology, 2021
The pathogenesis of Clostridioides difficile infection (CDI) was recognized with its link to the ... more The pathogenesis of Clostridioides difficile infection (CDI) was recognized with its link to the use of antimicrobials. Antimicrobials significantly alter gut microbiota structure and composition, which led to the discovery of the association of this gut perturbation with the development of CDI. A number of factors implicated in its pathogenesis, such as advancing age, proton-pump inhibitors, and gastrointestinal diseases, are linked to gut microbiota perturbations. In an effort to better understand CDI, a multitude of studies have tried to ascertain protective and predictive microbial footprints linked with CDI. It has further been realized that CDI in itself can alter the gut microbiome. Its spore-forming capability poses as an impediment in the management of the infection and contributes to its recurrence. Antibiotic therapies used for its management have also been linked to gut microbiota changes, making its treatment a little more challenging. In an effort to exploit and utiliz...
American Journal of Gastroenterology, 2021
large population across the US. Methods: We reviewed data from a commercial database (Explorys In... more large population across the US. Methods: We reviewed data from a commercial database (Explorys Inc, Cleveland, OH, USA) that provided electronic health records from 26 major integrated US healthcare systems. We included all individuals older than 30 years. Patients with Inflammatory Bowel Disease or family history of gastrointestinal malignancy were excluded. Based on the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), we identified cohorts of patients who had appendectomy prior to 2016 and they consisted the study group. Patients who had an intact appendix by 2016 served as control. A multivariate analysis with the main outcome being CRC, was performed and adjusted for age, gender, race, smoking, alcohol abuse, obesity, and diabetes mellitus. Results: Of 13,689,430 individuals in the database (2016-2021), 663,880 had undergone appendectomy prior to 2016 (study group). The prevalence of CRC in this group was 0.8%, which is double the prevalence detected in the control group who had an intact appendix (0.4%). Compared to controls, patients who had appendectomy were statistically more likely to develop CRC [OR: 1.52; 95% CI 1.23-1.69, P , 0.0001]. Predictors of CRC were age, male gender, non-white race, smoking, obesity (BMI . 30), alcohol abuse and diabetes. Being older than 65 years was, however was the strongest predictor. Conclusion: Our data revealed that appendectomy increases the risk of developing CRC compared to the general population. It is a large population study but is limited by its retrospective design, the unclear interval time between appendectomy and diagnosis of CRC, inability to determine cancer location, stage, and laboratory data which hindered adjustment for CRC risk. Appendectomy remains the best treatment option for appendicitis and its association with increased risk of CRC is at most debatable at this point. Prospective studies are needed to shed more light on this susceptibility.
American Journal of Gastroenterology, 2021
divided into 3 categories for comparison: GI alone, GI/respiratory and respiratory symptoms alone... more divided into 3 categories for comparison: GI alone, GI/respiratory and respiratory symptoms alone. Results: The sample included 170 patients who tested positive for COVID-19. Of those, ten (9.43%) purely had GI symptoms, including nausea, vomiting and/or diarrhea (NVD). Thirty four patients (32.1%) had both GI symptoms of NVD, as well as dyspnea, wheezing and/or cough. Mean temperature was febrile in the GI/respiratory category and respiratory diagnostic categories (38.5°C and 38.2°C respectively), while the GI category alone was 35.9°C, possibly indicating an association with greater inflammatory response. We found the LOS for GI/respiratory patients was a 19.9 days on average. Next longest was just GI symptoms at 18.1 and respiratory patients only was 15 days on average. Potential for GI and respiratory symptoms may suggest increased severity that correlates with longer length of ICU stay. Conclusion: The findings of this study revealed no significant difference in frequency of hospitalization, frequency of ICU admission, length of hospitalization, length of ICU stay, need for intubation, days intubated, need for pressers or mortality between patients with GI only, GI/respiratory or respiratory only symptoms. Understanding the association between markers of COVID-19 disease severity and principle disease category of symptoms may be clinically beneficial in better approximating infectious courses. The lack of significant association may be limited due to a small sample size.
American Journal of Gastroenterology, 2021
American Journal of Gastroenterology, 2021
Introduction: Frequent hospitalizations, systemic antibiotics and proton-pump inhibitor (PPI) use... more Introduction: Frequent hospitalizations, systemic antibiotics and proton-pump inhibitor (PPI) use are risk factors for Clostridioides difficile infection (CDI) in patients with cirrhosis. Hepatic encephalopathy (HE), a complication of cirrhosis, is managed with lactulose and/or rifaximin. Studies show a potential decrease in the risk of CDI with these therapies but have not compared the two treatments. We compare the effect of lactulose and rifaximin treatment on the risk of CDI development hypothesizing that rifaximin, given its activity against C. difficile, may decrease the risk of CDI. Methods: This was a multi-center retrospective study of all hospitalized cirrhotic patients treated for HE with lactulose and/or rifaximin at Mayo Clinic MN, FL and AZ from 2008-2013. Data on demographics, medications, admission, discharge, previous hospitalizations, antibiotic and PPI use, and dates of CDI episodes were gathered. Results: A total of 1112 hospitalizations in 1055 unique patients (55 had 1 subsequent readmission and 1 patient had 2) were found. Of these, 428 (40.6%) women with median age 58 years (interquartile range 52-65). C. difficile infection developed after 66/1112 (5.9%) hospitalizations within 12 months post-discharge. Of these, lactulose was administered in 21 (31.8%) hospitalizations, rifaximin in 5 (7.6%) and both in 40 (60.6%) hospitalizations. Systemic antibiotics were used in 28 (42.4%) admissions and PPIs in 60 (90.9%). Univariate analysis based only on medication (using lactulose alone as the reference group), regardless of dosage, showed that rifaximin alone was not significantly associated with CDI development as compared to lactulose alone (HR 1.57, 95% CI 0.57-4.33, P50.39). Use of both medications was also not significant when compared to lactulose alone (HR 1.41, 95% CI 0.84-2.38, P50.19). The results were similar after controlling for confounder variables. Multivariable analysis based on length of stay, age and gender showed no significant difference between rifaximin alone versus lactulose alone, and both medications versus lactulose alone for developing CDI. Conclusion: In our study, there was no significant difference between lactulose and rifaximin treatment on CDI development in patients with HE. While the use of both these medications might be safe, CDI should still be considered when managing HE in cirrhotic patients who develop diarrhea.
Therapeutic Advances in Gastroenterology, 2021
Inflammatory bowel disease (IBD) is a chronic disease of the intestinal tract that commonly prese... more Inflammatory bowel disease (IBD) is a chronic disease of the intestinal tract that commonly presents with diarrhea. Clostridioides difficile infection (CDI) is one of the most common complications associated with IBD that lead to flare-ups of underlying IBD. The pathophysiology of CDI includes perturbations of the gut microbiota, which makes IBD a risk factor due to the gut microbial alterations that occur in IBD, predisposing patients CDI even in the absence of antibiotics. Superimposed CDI not only worsens IBD symptoms but also leads to adverse outcomes, including treatment failure and an increased risk of hospitalization, surgery, and mortality. Due to the overlapping symptoms and concerns with false-positive molecular tests for CDI, diagnosing CDI in patients with IBD remains a clinical challenge. It is crucial to have a high index of suspicion for CDI in patients who seem to be experiencing an exacerbation of IBD symptoms. Vancomycin and fidaxomicin are the first-line treatment...
Infection and Drug Resistance, 2021
Background: Coronavirus infectious disease 2019 (COVID-19) is primarily a respiratory disease. Ho... more Background: Coronavirus infectious disease 2019 (COVID-19) is primarily a respiratory disease. However, it may manifest with gastrointestinal symptoms that may overlap with Clostridioides difficile infection (CDI). COVID-19 appears to have higher mortality in those with comorbidities. We aimed to assess the outcomes of coinfection in these patients. Methods: A retrospective chart review was conducted to identify patients with CDI and COVID-19 from January 1st, 2020 to November 17th, 2020. Both infections were diagnosed via PCR. Clinical features, treatment for COVID-19 and CDI and outcomes including intensive care unit admission, colectomy, 30 day-mortality and long-term complications were analyzed. Results: Overall, 21 patients (20 hospitalized) with median age 70.9 years (range 51.8-90.7 years) had CDI and COVID-19 within 4 weeks of each other. Of these, 4 patients (19%) with CDI were diagnosed with COVID-19 at the time of admission, 12 (57%) had CDI diagnosed after COVID-19, and 5 (23.9%) developed COVID-19 within 4 weeks after CDI. Fourteen patients (66.7%) were treated with medications directed against COVID-19 including remdesivir and dexamethasone (n=7), remdesivir with convalescent plasma (n= 1), remdesivir (n= 5) and dexamethasone (n=1). The most common treatment for CDI was oral vancomycin in 20 patients (95.2%), and 1 patient received intravenous metronidazole. No patient required colectomy for CDI but 2 (9.5%) required ICU admission. Four patients (19%) died likely due to COVID-19 with median age 80 years (range 61-90 years). Conclusion: The relationship between COVID-19 and CDI is poorly understood, and studies are required to further investigate this association. Whether coinfection results in a worsening of outcomes, including mortality and clinical course, are questions that should be answered in future research studies. Diagnosing both infections for appropriate management is vital in light of overlapping symptoms.
Clinical Gastroenterology and Hepatology
Therapeutic Advances in Gastroenterology
Background: Microscopic colitis (MC) causes chronic diarrhea. It has two histologic subtypes: lym... more Background: Microscopic colitis (MC) causes chronic diarrhea. It has two histologic subtypes: lymphocytic colitis (LC) and collagenous colitis (CC). Little is known about the natural progression of disease with time and with treatment. Objectives: We aimed to assess histological changes over time. Design: We designed a retrospective study including adults diagnosed with MC from January 1992 to January 2020 at Mayo Clinic. Methods: Pathology reports were reviewed until 31 October 2020. Histological assessments at least 8 weeks apart were considered as adequate follow-up. Histological change from one subtype to the other and resolution were tracked with univariate and multivariable Cox proportional hazards models. Results: Overall, 416 patients with a median age at diagnosis of 63.9 years with >1 histopathological assessment were identified. Histology at initial diagnosis was CC in 218 (52.4%) patients and LC in 198 (47.6%). No medications were associated with a histological change...
American Journal of Gastroenterology
American Journal of Gastroenterology
American Journal of Gastroenterology
American Journal of Gastroenterology
INTRODUCTION Outcomes and safety of budesonide maintenance therapy in microscopic colitis (MC) ar... more INTRODUCTION Outcomes and safety of budesonide maintenance therapy in microscopic colitis (MC) are not well known. METHODS Adult residents of Olmsted County, Minnesota diagnosed with MC (2002-2019) and treated with budesonide were identified using the Rochester Epidemiology Project. Response was assessed at 12 +/- 4 weeks after initiation of therapy and defined as complete (resolution of diarrhea), partial (≥50% improvement in number of bowel movements), nonresponse (<50% improvement), and intolerance (discontinued due to side-effects). For safety outcomes, cases (budesonide maintenance) and MC controls (no budesonide therapy) were matched by gender and age at diagnosis (+/-2 years). RESULTS A total of 450 patients were identified, of which 162 (36.0%) were treated with budesonide for induction of clinical remission [median age 67 (23-91) years and 126 (77.8%) female]. Clinical outcomes for induction were as follows: 130 (80.2%) complete response, 22 (13.6%) partial response, 8 (4.9%) no response, and 2 (1.2%) intolerance. After induction, 96 (63.2%) had recurrence after discontinuation; 27 (28.1%) required further budesonide induction treatment without maintenance, 56 (58.3%) required long-term budesonide maintenance, and 13 (13.5%) were treated with other therapies. Of those receiving budesonide maintenance, all responded [55 (98.2%) complete, 1 (1.8%) partial]. No patient stopped maintenance from adverse events. The median duration of follow-up was 5.6 years (0.3-18.9). There was no significant difference between cases and controls in the incidence of osteopenia/ osteoporosis, diabetes mellitus, hypertension, glaucoma, or cataracts. CONCLUSION The long-term use of budesonide in MC appears to be effective and generally well tolerated with limited adverse effects.
Therapeutic Advances in Gastroenterology, 2021
The pathogenesis of Clostridioides difficile infection (CDI) has largely been attributed to the a... more The pathogenesis of Clostridioides difficile infection (CDI) has largely been attributed to the action of two major toxins – A and B. An enhanced systemic humoral immune response against these toxins has been shown to be protective against recurrent CDI. Over the years, fully human monoclonal antibodies against both of these toxins have been developed in an attempt to counter the increasing incidence of recurrent CDI. Clinical trials conducted to evaluate the efficacy of anti-toxin A monoclonal antibody, actoxumab, and anti-toxin B monoclonal antibody, bezlotoxumab, demonstrated that bezlotoxumab substantially lowered the rate of recurrent infection, while actoxumab did not. A significant therapeutic benefit was appreciated in patients with at least one high-risk factor for recurrence, including, age ⩾65 years, immunocompromised state, prior CDI and severe CDI. In light of toxins A and B being immunogenic, vaccine trials are underway with the aim to prevent primary infection.
Therapeutic Advances in Gastroenterology, 2021
The pathogenesis of Clostridioides difficile infection (CDI) was recognized with its link to the ... more The pathogenesis of Clostridioides difficile infection (CDI) was recognized with its link to the use of antimicrobials. Antimicrobials significantly alter gut microbiota structure and composition, which led to the discovery of the association of this gut perturbation with the development of CDI. A number of factors implicated in its pathogenesis, such as advancing age, proton-pump inhibitors, and gastrointestinal diseases, are linked to gut microbiota perturbations. In an effort to better understand CDI, a multitude of studies have tried to ascertain protective and predictive microbial footprints linked with CDI. It has further been realized that CDI in itself can alter the gut microbiome. Its spore-forming capability poses as an impediment in the management of the infection and contributes to its recurrence. Antibiotic therapies used for its management have also been linked to gut microbiota changes, making its treatment a little more challenging. In an effort to exploit and utiliz...
American Journal of Gastroenterology, 2021
large population across the US. Methods: We reviewed data from a commercial database (Explorys In... more large population across the US. Methods: We reviewed data from a commercial database (Explorys Inc, Cleveland, OH, USA) that provided electronic health records from 26 major integrated US healthcare systems. We included all individuals older than 30 years. Patients with Inflammatory Bowel Disease or family history of gastrointestinal malignancy were excluded. Based on the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), we identified cohorts of patients who had appendectomy prior to 2016 and they consisted the study group. Patients who had an intact appendix by 2016 served as control. A multivariate analysis with the main outcome being CRC, was performed and adjusted for age, gender, race, smoking, alcohol abuse, obesity, and diabetes mellitus. Results: Of 13,689,430 individuals in the database (2016-2021), 663,880 had undergone appendectomy prior to 2016 (study group). The prevalence of CRC in this group was 0.8%, which is double the prevalence detected in the control group who had an intact appendix (0.4%). Compared to controls, patients who had appendectomy were statistically more likely to develop CRC [OR: 1.52; 95% CI 1.23-1.69, P , 0.0001]. Predictors of CRC were age, male gender, non-white race, smoking, obesity (BMI . 30), alcohol abuse and diabetes. Being older than 65 years was, however was the strongest predictor. Conclusion: Our data revealed that appendectomy increases the risk of developing CRC compared to the general population. It is a large population study but is limited by its retrospective design, the unclear interval time between appendectomy and diagnosis of CRC, inability to determine cancer location, stage, and laboratory data which hindered adjustment for CRC risk. Appendectomy remains the best treatment option for appendicitis and its association with increased risk of CRC is at most debatable at this point. Prospective studies are needed to shed more light on this susceptibility.
American Journal of Gastroenterology, 2021
divided into 3 categories for comparison: GI alone, GI/respiratory and respiratory symptoms alone... more divided into 3 categories for comparison: GI alone, GI/respiratory and respiratory symptoms alone. Results: The sample included 170 patients who tested positive for COVID-19. Of those, ten (9.43%) purely had GI symptoms, including nausea, vomiting and/or diarrhea (NVD). Thirty four patients (32.1%) had both GI symptoms of NVD, as well as dyspnea, wheezing and/or cough. Mean temperature was febrile in the GI/respiratory category and respiratory diagnostic categories (38.5°C and 38.2°C respectively), while the GI category alone was 35.9°C, possibly indicating an association with greater inflammatory response. We found the LOS for GI/respiratory patients was a 19.9 days on average. Next longest was just GI symptoms at 18.1 and respiratory patients only was 15 days on average. Potential for GI and respiratory symptoms may suggest increased severity that correlates with longer length of ICU stay. Conclusion: The findings of this study revealed no significant difference in frequency of hospitalization, frequency of ICU admission, length of hospitalization, length of ICU stay, need for intubation, days intubated, need for pressers or mortality between patients with GI only, GI/respiratory or respiratory only symptoms. Understanding the association between markers of COVID-19 disease severity and principle disease category of symptoms may be clinically beneficial in better approximating infectious courses. The lack of significant association may be limited due to a small sample size.
American Journal of Gastroenterology, 2021
American Journal of Gastroenterology, 2021
Introduction: Frequent hospitalizations, systemic antibiotics and proton-pump inhibitor (PPI) use... more Introduction: Frequent hospitalizations, systemic antibiotics and proton-pump inhibitor (PPI) use are risk factors for Clostridioides difficile infection (CDI) in patients with cirrhosis. Hepatic encephalopathy (HE), a complication of cirrhosis, is managed with lactulose and/or rifaximin. Studies show a potential decrease in the risk of CDI with these therapies but have not compared the two treatments. We compare the effect of lactulose and rifaximin treatment on the risk of CDI development hypothesizing that rifaximin, given its activity against C. difficile, may decrease the risk of CDI. Methods: This was a multi-center retrospective study of all hospitalized cirrhotic patients treated for HE with lactulose and/or rifaximin at Mayo Clinic MN, FL and AZ from 2008-2013. Data on demographics, medications, admission, discharge, previous hospitalizations, antibiotic and PPI use, and dates of CDI episodes were gathered. Results: A total of 1112 hospitalizations in 1055 unique patients (55 had 1 subsequent readmission and 1 patient had 2) were found. Of these, 428 (40.6%) women with median age 58 years (interquartile range 52-65). C. difficile infection developed after 66/1112 (5.9%) hospitalizations within 12 months post-discharge. Of these, lactulose was administered in 21 (31.8%) hospitalizations, rifaximin in 5 (7.6%) and both in 40 (60.6%) hospitalizations. Systemic antibiotics were used in 28 (42.4%) admissions and PPIs in 60 (90.9%). Univariate analysis based only on medication (using lactulose alone as the reference group), regardless of dosage, showed that rifaximin alone was not significantly associated with CDI development as compared to lactulose alone (HR 1.57, 95% CI 0.57-4.33, P50.39). Use of both medications was also not significant when compared to lactulose alone (HR 1.41, 95% CI 0.84-2.38, P50.19). The results were similar after controlling for confounder variables. Multivariable analysis based on length of stay, age and gender showed no significant difference between rifaximin alone versus lactulose alone, and both medications versus lactulose alone for developing CDI. Conclusion: In our study, there was no significant difference between lactulose and rifaximin treatment on CDI development in patients with HE. While the use of both these medications might be safe, CDI should still be considered when managing HE in cirrhotic patients who develop diarrhea.
Therapeutic Advances in Gastroenterology, 2021
Inflammatory bowel disease (IBD) is a chronic disease of the intestinal tract that commonly prese... more Inflammatory bowel disease (IBD) is a chronic disease of the intestinal tract that commonly presents with diarrhea. Clostridioides difficile infection (CDI) is one of the most common complications associated with IBD that lead to flare-ups of underlying IBD. The pathophysiology of CDI includes perturbations of the gut microbiota, which makes IBD a risk factor due to the gut microbial alterations that occur in IBD, predisposing patients CDI even in the absence of antibiotics. Superimposed CDI not only worsens IBD symptoms but also leads to adverse outcomes, including treatment failure and an increased risk of hospitalization, surgery, and mortality. Due to the overlapping symptoms and concerns with false-positive molecular tests for CDI, diagnosing CDI in patients with IBD remains a clinical challenge. It is crucial to have a high index of suspicion for CDI in patients who seem to be experiencing an exacerbation of IBD symptoms. Vancomycin and fidaxomicin are the first-line treatment...
Infection and Drug Resistance, 2021
Background: Coronavirus infectious disease 2019 (COVID-19) is primarily a respiratory disease. Ho... more Background: Coronavirus infectious disease 2019 (COVID-19) is primarily a respiratory disease. However, it may manifest with gastrointestinal symptoms that may overlap with Clostridioides difficile infection (CDI). COVID-19 appears to have higher mortality in those with comorbidities. We aimed to assess the outcomes of coinfection in these patients. Methods: A retrospective chart review was conducted to identify patients with CDI and COVID-19 from January 1st, 2020 to November 17th, 2020. Both infections were diagnosed via PCR. Clinical features, treatment for COVID-19 and CDI and outcomes including intensive care unit admission, colectomy, 30 day-mortality and long-term complications were analyzed. Results: Overall, 21 patients (20 hospitalized) with median age 70.9 years (range 51.8-90.7 years) had CDI and COVID-19 within 4 weeks of each other. Of these, 4 patients (19%) with CDI were diagnosed with COVID-19 at the time of admission, 12 (57%) had CDI diagnosed after COVID-19, and 5 (23.9%) developed COVID-19 within 4 weeks after CDI. Fourteen patients (66.7%) were treated with medications directed against COVID-19 including remdesivir and dexamethasone (n=7), remdesivir with convalescent plasma (n= 1), remdesivir (n= 5) and dexamethasone (n=1). The most common treatment for CDI was oral vancomycin in 20 patients (95.2%), and 1 patient received intravenous metronidazole. No patient required colectomy for CDI but 2 (9.5%) required ICU admission. Four patients (19%) died likely due to COVID-19 with median age 80 years (range 61-90 years). Conclusion: The relationship between COVID-19 and CDI is poorly understood, and studies are required to further investigate this association. Whether coinfection results in a worsening of outcomes, including mortality and clinical course, are questions that should be answered in future research studies. Diagnosing both infections for appropriate management is vital in light of overlapping symptoms.