South African Society of Clinical Microbiology Clostridioides difficile infection diagnosis, management and infection prevention and control guideline

Abstract

Clostridioides difficile infection (CDI) is a problem in both developed and developing countries and is a common hospital-acquired infection. This guideline provides evidence-based practical recommendations for South Africa and other developing countries. The scope of the guideline includes CDI diagnostic approaches; adult, paediatric and special populations treatment options; and surveillance and infection prevention and control recommendations.

Epidemiology and aetiology of moderate to severe diarrhoea in hospitalised HIV-infected patients ≥5 years old in South Africa, 2018-2021: a case-control analysis

“…The case definition, as per the guidelines for diagnostic and clinical management of C. difficile from the South African Society for Clinical Microbiology, includes onset of diarrhoea more than 48 hours after admission, or diarrhoea that continues for 3 days post admission and where there is no likely alternatively cause (no other pathogens detected or use of laxatives), or where the patient has had an admission or antibiotics use in the past 12 weeks. 40 Three of the 14 cases did not match this case definition as they did not have an admission in the past 12 weeks and had multiple pathogens detected on PCR. These three cases were however HIV-infected.…”

Risk Factors Associated with Suspected Clostridium difficile Infection (CDI) in Elderly Diarrhea Patients at Prof. Dr. I.G.N.G. Ngoerah Hospital

“…C. difficile spores can survive for a long time on inanimate objects (resistant to heat, acids, and antibiotics), which is the main reason why these bacteria can cause infection in patients with long hospitalizations in health care facilities. 3,5,7,9 C. difficile spreads via the fecal-oral route and causes disease in humans through the production of two protein exotoxins (toxin A and toxin B) that are cytotoxic to colonic epithelial cells. 11,12 Almost any antibiotic can increase susceptibility to CDI infection, but cephalosporins, fluoroquinolones, clindamycin and certain penicillins (eg coamoxiclav) increase the risk to a greater extent.…”

“…21,22 Chemotherapy that disrupts the gut microbiome and causes mucositis may make germination of C. difficile spores more common, leading to greater virulence. [1][2][3][4][5][6][7] While CDI rates in patients with cancer vary between studies, that is, 10% during chemotherapy and up to 20% risk overall. 11-15 A total of 59 patients (84.3%) had a history of decreased immune system.…”

“…One study reported that eight strains of C. difficile appeared in healthy people, while another study showed that the prevalence of C. difficile (toxin A) was 1.3% in communities and hospitals in Jakarta. 6,7 The latest report from Central Java showed a CDI prevalence of 20.6% in 2017. 8 Several risk factors, including advanced age, exposure to antibiotics, and hospitalization, are strongly associated with CDI.…”

Epidemiology and aetiology of moderate to severe diarrhoea in hospitalised patients ≥5 years old living with HIV in South Africa, 2018–2021: A case-control analysis

“…It is important to distinguish C. difficile colonisation from disease to avoid unnecessary antimicrobial therapy. The case definition, as per the guidelines for diagnostic and clinical management of C. difficile from the South African Society for Clinical Microbiology, includes onset of diarrhoea more than 48 hours after admission, or diarrhoea that continues for 3 days post admission and where there is no likely alternatively cause (no other pathogens detected or use of laxatives), or where the patient has had an admission or antibiotics use in the past 12 weeks [41]. Three of the 14 cases did not match this case definition as they did not have an admission in the past 12 weeks and had multiple pathogens detected on PCR.…”