Management of patients presenting with diarrhoea to a regional emergency department in KwaZulu-Natal:  Call for clearer, more relevant guidance

Kudsk‐Iversen, Søren; Gilbert, John; Azarath, Anneshree

doi:10.4102/sajhivmed.v15i3.9

Cited by 2 publications

(3 citation statements)

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“…South African National Department of Health guidelines for the treatment of diarrhoea are included in the standard treatment guidelines and essential medicines list (hospital and primary healthcare levels) [ 4 , 5 ]. An audit at a provincial hospital in KwaZulu-Natal found that patients with diarrhoea were managed inconsistently, specifically with regards to antibiotic treatment, which could result in an increased risk of antibiotic resistance and infection with Clostridioides difficile (C. difficile) [ 6 ]. The study reported that stool samples were submitted for routine microscopy (examination for ova and parasites) and culture in 47% of cases, yet 60% of cases were treated with antibiotics (only 35% of which had positive culture results).…”

Section: Introductionmentioning

confidence: 99%

“…The study reported that stool samples were submitted for routine microscopy (examination for ova and parasites) and culture in 47% of cases, yet 60% of cases were treated with antibiotics (only 35% of which had positive culture results). The authors called for clearer national guidelines for the management of diarrhoea, particularly for HIV-infected patients who comprised the majority (81%) of diarrhoeal cases presenting to the emergency department [ 6 ]. Robust epidemiological and aetiological data are needed to formulate nationally relevant guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic testing practices for diarrhoeal cases in South African public hospitals

et al. 2022

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Background Stool samples submitted for diagnostic testing represent a proportion of diarrhoeal cases seeking healthcare, and an even smaller proportion of diarrhoeal cases in the community. Despite this, surveillance relies heavily on these laboratory results. This study described diarrhoeal diagnostic practices and aetiological agents of diarrhoea in patients admitted to three South African public hospitals in order to understand biases in surveillance data, and inform guidelines, diagnostic and laboratory practices to improve clinical management. Methods A doctors’ survey was conducted to determine sample submission, diarrhoeal treatment and barriers to submitting samples for testing. Results for all samples submitted for routine diagnostics were obtained from the NHLS Central Data Warehouse. An enhanced surveillance study enrolled patients with acute diarrhoea at the same hospitals over the same period. Differences between routine culture results and molecular testing from the surveillance study were described. Results Stool samples were seldom submitted for diagnostic testing (median of 10% of admitted cases). Current diagnostic guidelines were not useful, hence most doctors (75.1%) relied on their own clinical judgement or judgement of a senior clinician. Although most doctors (90.3%) agreed that diagnostics were helpful for clinical management, they reported patients being unwilling to provide samples and long laboratory turnaround times. Routine diagnostic data represent cases with chronic diarrhoea and dysentery since doctors are most likely to submit specimens for these cases. Pathogen yield (number of pathogens detected for samples tested for specific pathogens) was significantly higher in the surveillance study, which used molecular methods, than through routine diagnostic services (73.3% versus 8.2%, p < 0.001), including for viruses (48.9% versus 2.6%, p < 0.001), bacteria (40.1% versus 2.2%, p < 0.001) and parasites (16.2% versus 3.6%, p < 0.001). Despite viruses being commonly detected in the surveillance study, viral testing was seldom requested in routine diagnostic investigations. Conclusions Comprehensive diagnostic and treatment guidelines are required for diarrhoeal diseases. These guidelines should be informed by local epidemiological data, where diagnostic testing is reserved for cases most likely to benefit from specific treatment. Optimisation of current diagnostic processes and methods are required for these cases, specifically in terms of minimising turnaround times while maximising diagnostic acumen.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic testing practices for diarrhoeal cases in South African public hospitals

et al. 2022

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“…In patients presenting to the Emergency department with a chief complaint of diarrhea, a South African study conducted by Kudsk-Iversen et al, showed that 60% of these patients received antibiotics, yet only 34% had an organism identified on stool microscopy or culture. In all cases, the final diagnosis was listed as acute gastroenteritis without further specification and antibiotic use according to national guidelines appeared inconsistent 15 .…”

Section: Introductionmentioning

confidence: 99%

Antibiotic prescribing patterns in Emergency Department at Regional Hospital in South Africa

Almansoori¹,

Parag²

2021

Afr H. Sci.

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Background: Antibiotic resistance is a major public health concern. The Emergency department (ED) is the community gate for healthcare where antibiotics are often prescribed. However, there is a paucity of data regarding antibiotic prescriptionpractices in Africa. Objectives: To describe the use of antibiotics in an ED and level of prescribing adherence to national guidelines. Methods: Retrospective observational study of antibiotic practice in ED. All patients who presented to ED during the study period and were prescribed an anti-microbial agent were included. Data on demographics, working diagnosis, anti-microbialprescribed, dose, route and prescriber level were used to provide descriptive statistics of these parameters. Results: We identified 195 (13.4%) patients who received anti-microbial therapy among 1454 charts reviewed. The mean age was 34.8 with male predominance. The most common indication identified was abscess in 37 (30.8%) patients and in general surgical conditions had the highest rate of antimicrobials prescribed at 54.3%. In addition, co-amoxiclav was the most commonly prescribed anti-microbial (72.15%). We found that combination therapy was not common practice in ED, with majority of the patients having received single anti-microbial therapy (87.18%). The appropriateness of antimicrobial prescriptions was (46.2%) and not statistically significant (P = 0.654). Conclusion: The most commonly prescribed anti-microbial was co amoxiclav and the most common indication was abscess. It was found that antibiotic prescription appropriateness was acceptable when compared to studies conducted in developedcountries. However, further research within other hospital departments will add to the study to determine the adherence as an institution rather than the Emergency department alone, as antimicrobial resistance is a major global healthcare problemand impacts patient care throughout the care pathway. Keywords: Antimicrobial resistance; antibiotic stewardship; emergency department.

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Management of patients presenting with diarrhoea to a regional emergency department in KwaZulu-Natal: Call for clearer, more relevant guidance

Cited by 2 publications

References 10 publications

Diagnostic testing practices for diarrhoeal cases in South African public hospitals

Diagnostic testing practices for diarrhoeal cases in South African public hospitals

Antibiotic prescribing patterns in Emergency Department at Regional Hospital in South Africa

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