The Clostridium difficile problem: A South African tertiary institution's prospective perspective

Rajabally, Naayil; Pentecost, Michelle; Pretorius, Gert; Whitelaw, Andrew; Mendelson, Marc; Watermeyer, Gillian

doi:10.7196/samj.6012

Cited by 29 publications

(32 citation statements)

References 25 publications

(23 reference statements)

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“…In three studies, which assessed recent antibiotic usage, there was a significant association between antibiotic usage and CDI; however, no studies were designed to implicate individual antibiotics, nor to describe the nature of antibiotic usage. 29,30,34 These findings are consistent with the well-described risk factor of antibiotic usage in high-resourced healthcare systems. In three of four studies that assessed association with HIV status, no association was found.…”

Section: Discussionsupporting

confidence: 78%

Clostridium difficile: A healthcare-associated infection of unknown significance in adults in sub-Saharan Africa

et al. 2016

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Background Clostridium difficile infection (CDI) causes a high burden of disease in high-resource healthcare systems, with significant morbidity, mortality, and financial implications. CDI is a healthcare-associated infection for which the primary risk factor is antibiotic usage, and it is the leading cause of bacterial diarrhoea in HIV-infected patients in the United States. Little is known about the disease burden of CDI in sub-Saharan Africa, where HIV and healthcare-associated infections have higher prevalences, and antibiotic usage is less restricted. This article reviews published literature on CDI in sub-Saharan Africa, highlighting areas for future research. Methods English language publications since 1995 were identified from online databases (PubMed, Medline, Google Scholar, and SCOPUS), using combinations of keywords "C. difficile", "Africa", and "HIV". Results Ten relevant studies were identified. There was considerable variation in methodology to assess for carriage of toxigenic C. difficile and its associations. Eight studies reported carriage of toxigenic C. difficile. Three (of three) studies found an association with antibiotic usage. One (of four) studies showed an association with HIV infection. One study showed no association with degree of immunosuppression in HIV. Two (of three) studies showed an association between carriage of toxigenic C. difficile and diarrhoeal illness. Conclusions While the carriage of toxigenic C. difficile is well described in sub-Saharan Africa, the impact of CDI in the region remains poorly understood and warrants further research.

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Section: Discussionsupporting

confidence: 78%

Clostridium difficile: A healthcare-associated infection of unknown significance in adults in sub-Saharan Africa

et al. 2016

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“…Twenty‐five studies met criteria for qualitative synthesis (Table ) . Twenty (80%) were observational studies, three (12%) studies were case–control and two (8%) were cohort studies.…”

Section: Resultsmentioning

confidence: 99%

Clostridium difficile infection in low‐ and middle‐human development index countries: a systematic review

Forrester

Cai

Mbanje

et al. 2017

Tropical Med Int Health

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Abstractobjective To describe the impact and epidemiology of Clostridium difficile infection (CDI) in lowand middle-human development index (LMHDI) countries.method Prospectively registered, systematic literature review of existing literature in the PubMed, Ovid and Web of Science databases describing the epidemiology and management of C. difficile in LMHDI countries. Risk factors were compared between studies when available.results Of the 218 abstracts identified after applying search criteria, 25 studies were reviewed in detail. The weighted pooled infection rate among symptomatic non-immunosuppressed inpatients was 15.8% (95% CI 12.1-19.5%) and was 10.1% (95% CI 3.0-17.2%) among symptomatic outpatients. Subgroup analysis of immunosuppressed patient populations revealed pooled infection rates similar to non-immunosuppressed patient populations. Risk factor analysis was infrequently performed.conclusions While the percentages of patients with CDI in LMHDI countries among the reviewed studies are lower than expected, there remains a paucity of epidemiologic data evaluating burden of C. difficile infection in these settings.keywords C. difficile infection, low-and middle-income countries, systematic review

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“…In developing countries, a growing proportion of nosocomial infections can be assigned to methicillin-resistant S. aureus (MRSA) and multi-drug resistant Gram-negative bacteria [9, 10]. A survey done in an Argentinean general hospital revealed incidence rates of Clostridium difficile, the commonest cause of nosocomial infectious diarrhoea to range from 37 to 84 cases per 10,000 admissions between 2000 and 2005 while the annual incidence of the same infection was 8.7 cases/10 000 hospitalisations in a study done in South Africa [11, 12]. …”

Section: Introductionmentioning

confidence: 99%

Implementation of infection control in health facilities in Arua district, Uganda: a cross-sectional study

et al. 2015

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BackgroundAt least 1.4 million people are affected globally by nosocomial infections at any one time, the vast majority of these occurring in low-income countries. Most of these infections can be prevented by adopting inexpensive infection prevention and control measures such as hand washing. We assessed the implementation of infection control in health facilities and determined predictors of hand washing among healthcare workers (HCWs) in Arua district, Uganda.MethodsWe interviewed 202 HCWs that included 186 randomly selected and 16 purposively selected key informants in this cross-sectional study. We also conducted observations in 32 health facilities for compliance with infection control measures and availability of relevant supplies for their implementation. Quantitative data underwent descriptive analysis and multiple logistic regressions at 95 % confidence interval while qualitative data was coded and thematically analysed.ResultsMost respondents (95/186, 51 %) were aware of at least six of the eight major infection control measures assessed. Most facilities (93.8 %, 30/32) lacked infection control committees and adequate supplies or equipment for infection control. Respondents were more likely to wash their hands if they had prior training on infection control (AOR = 2.71, 95 % CI: 1.03–7.16), had obtained at least 11 years of formal education (AOR = 3.30, 95 % CI: 1.44–7.54) and had reported to have acquired a nosocomial infection (AOR = 2.84, 95 % CI: 1.03–7.84).ConclusionsHealthcare workers are more likely to wash their hands if they have ever suffered from a nosocomial infection, received in-service training on infection control, were educated beyond ordinary level, or knew hand washing as one of the infection control measures. The Uganda Ministry of Health should provide regular in-service training in infection control measures and adequate necessary materials.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0999-4) contains supplementary material, which is available to authorized users.

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The Clostridium difficile problem: A South African tertiary institution's prospective perspective

Cited by 29 publications

References 25 publications

Clostridium difficile: A healthcare-associated infection of unknown significance in adults in sub-Saharan Africa

Clostridium difficile: A healthcare-associated infection of unknown significance in adults in sub-Saharan Africa

Clostridium difficile infection in low‐ and middle‐human development index countries: a systematic review

Implementation of infection control in health facilities in Arua district, Uganda: a cross-sectional study

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