Epidemiology and outcomes of <i>Clostridium difficile</i> infection among hospitalised patients: results of a multicentre retrospective study in South Africa

Legenza, Laurel; Barnett, Susanne G.; Rose, Warren E.; Bianchini, Monica; Safdar, Nasia; Coetzee, Renier

doi:10.1136/bmjgh-2018-000889

Cited by 20 publications

(16 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The long duration of TB treatment induces long-standing disruption in the gut microbiota, persisting long after the stopping of TB treatment. It was shown in South African cohorts that C. diff strains involved in CDI in patients treated for TB have high levels of resistance to rifampicin and fluoroquinolones (including moxifloxacin), a feature of the C. diff populations circulating among TB patients (21,22). In our study, we noticed a predominance of old age, a slight predominance of male subjects and urban domicile in patients with CDI.…”

Section: Discussionsupporting

confidence: 53%

Profile of patients admitted in a pulmonology ward and developing Clostridium difficile enterocolitis

et al. 2019

View full text Add to dashboard Cite

Clostridium difficile is an anaerobic bacterium than can colonise the lower intestine and cause enterocolitis in susceptible patients. Clostridium difficile infection (CDI) is typically a nosocomial infection, favoured by treatment with antibiotics (especially with broad-spectrum drugs), proton pump inhibitors, but also comorbidities, old age and prolonged hospitalisation. Based on the observation that in the past years, the frequency of nosocomial CDI has increased in the Institute of Pulmonology, Bucharest, this retrospective observational study aimed to analyse the characteristics of admitted patients who develop CDI, in order to identify possible particular features and risk factors. Accordingly, medical files from 80 patients admitted from January 2015 to August 2017 were analysed for demographic data, respiratory diagnosis, comorbidities, blood tests, treatments prescribed, time of CDI onset, evolution and outcome. The number of patients studied was 29 in 2015, 16 in 2016 and 35 in 2017, with slight male predominance. Totally, 54 patients (67.5%) had tuberculosis (pulmonary or pleural), 12 had lung cancer, five had respiratory infections, two had chronic obstructive pulmonary disease and seven had other diseases. All patients but nine were receiving antibiotics: tuberculosis drugs, cephalosporins, fluoroquinolones and beta-lactams. About half of the patients received proton pump inhibitors. Most patients had several comorbidities. Mean time since admittance to onset of diarrhoea was 20 days. CDI was treated with metronidazole or vancomycin. The evolution was favourable in 90% of patients, but eight patients (10%) died This study highlights a high frequency of CDI in patients treated for tuberculosis. Due to insufficient data, no epidemiological consideration could be made. Further studies are needed to assess the relationship among tuberculosis, tuberculosis treatment and CDI.

show abstract

Section: Discussionsupporting

confidence: 53%

Profile of patients admitted in a pulmonology ward and developing Clostridium difficile enterocolitis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The antibiotic treatment in the pediatrics department includes ampicillin and gentamicin as the first line and third-generation cephalosporin as the second line. All children who were C. difficile positive were treated by metronidazole as recommended by South Africa treatment guidelines for CDI [26].…”

Section: Laboratorymentioning

confidence: 99%

High Clostridium difficile Infection among HIV-Infected Children with Diarrhea in a Tertiary Hospital in Mwanza, Tanzania

Seugendo

Hokororo

Kabyemera

et al. 2020

International Journal of Pediatrics

View full text Add to dashboard Cite

Clostridium difficile causes a million of illnesses each year worldwide and can affect people of all ages. Limited data exist on the prevalence of C. difficile infections (CDI) among children below five years of age in developing countries. This study is aimed at determining the prevalence, associated factors, and outcome of the Clostridium difficile infection among children with diarrhea attending a tertiary hospital in Mwanza, Tanzania. Stool samples were collected and cultured anaerobically to isolate Clostridium difficile, followed by C. difficile toxin A and B assay and ribotyping. A total of 301 children with diarrhea were enrolled. A total of 22 (7.31%, 95% CI: 0.89-0.95) nonrepetitive stool samples were positive for Clostridium difficile. Eighteen (81%) of C. difficile isolates were toxigenic, and 16 (72.7%) had unknown ribotypes. Independent predictors of positive C. difficile were as follows: positive HIV status, hospital stay of more than four days, high stool leukocyte count, and watery stool. Clostridium difficile-positive children had significantly higher median duration of the diarrhea than those without C. difficile. Clinicians should consider C. difficile as a possible cause of diarrhea in children living in developing countries and institute appropriate management to prevent associated morbidities and mortalities. Furthermore, there is a need of joint effort to improve C. difficile diagnosis and surveillance in developing countries to establish the unknown epidemiology of CDI in these countries.

show abstract

“…Where limited data exists, a study at a tertiary hospital in Cape Town, South Africa found 22% of stool samples from patients with suspected CDI diarrhoea were C. difficile positive [2]. In addition, patients in South Africa are disproportionately affected by HIV and tuberculosis (TB) and therefore also experience known CDI risk factors of prior hospital and antibiotic exposure-exposures that can uniquely contribute to an increased risk of CDI and poor outcomes [3,4].…”

Section: Outbreaks Have Been Reported Extensively In Thementioning

confidence: 99%

“…This study reveals a more complicated process for obtaining and administering vancomycin compared to metronidazole that may be hindering healthcare providers' use of vancomycin. In an epidemiology, treatment, and outcomes study in the same setting, vancomycin was rarely ordered (2%) as initial CDI treatment [4]. One strategy is to incorporate treatment options for CDI into pharmacist education and teach pharmacists what to look for on physician-submitted motivation forms.…”

Section: Implications: Perceptions and Knowledgementioning

confidence: 99%

Clostridium difficile infection perceptions and practices: a multicenter qualitative study in South Africa

Legenza

Barnett

Rose

et al. 2018

Antimicrob Resist Infect Control

Self Cite

View full text Add to dashboard Cite

BackgroundClostridium difficile infection (CDI) is understudied in limited resource settings. In addition, provider awareness of CDI as a prevalent threat is unknown. An assessment of current facilitators and barriers to CDI identification, management, and prevention is needed in limited resource settings to design and evaluate quality improvement strategies to effectively minimize the risk of CDI.MethodsOur study aimed to identify CDI perceptions and practices among healthcare providers in South African secondary hospitals to identify facilitators and barriers to providing quality CDI care. Qualitative interviews (11 physicians, 11 nurses, 4 pharmacists,) and two focus groups (7 nurses, 3 pharmacists) were conducted at three district level hospitals in the Cape Town Metropole. Semi-structured interviews elicited provider perceived facilitators, barriers, and opportunities to improve clinical workflow from patient presentation through CDI (1) Identification, (2) Diagnosis, (3) Treatment, and (4) Prevention. In addition, a summary provider CDI knowledge score was calculated for each interviewee for seven components of CDI and management.ResultsMajor barriers identified were knowledge gaps in characteristics of C. difficile identification, diagnosis, treatment, and prevention. The median overall CDI knowledge score (scale 0–7) from individual interviews was 3 [interquartile range 0.25, 4.75]. Delays in C. difficile testing workflow were identified. Participants perceived supplies for CDI management and prevention were usually available; however, hand hygiene and use of contact precautions was inconsistent.ConclusionsOur analysis provides a detailed description of the facilitators and barriers to CDI workflow and can be utilized to design quality improvement interventions among limited resource settings.

show abstract

Epidemiology and outcomes of Clostridium difficile infection among hospitalised patients: results of a multicentre retrospective study in South Africa

Cited by 20 publications

References 23 publications

Profile of patients admitted in a pulmonology ward and developing Clostridium difficile enterocolitis

Profile of patients admitted in a pulmonology ward and developing Clostridium difficile enterocolitis

High Clostridium difficile Infection among HIV-Infected Children with Diarrhea in a Tertiary Hospital in Mwanza, Tanzania

Clostridium difficile infection perceptions and practices: a multicenter qualitative study in South Africa

Contact Info

Product

Resources

About