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

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dc.contributor.authorRajabally, N M
dc.contributor.authorPentecost, M
dc.contributor.authorPretorius, G
dc.contributor.authorWhitelaw, A
dc.contributor.authorMendelson, M
dc.contributor.authorWatermeyer, G
dc.date.accessioned2021-10-08T07:20:26Z
dc.date.available2021-10-08T07:20:26Z
dc.date.issued2013
dc.description.abstractBACKGROUND AND OBJECTIVES: The aim of this study is to report the incidence of Clostridium difficile-associated disease (CDAD) in a tertiary-care hospital in South Africa and to identify risk factors, assess patient outcomes and determine the impact of the hypervirulent strain of the organism referred to as North American pulsed-field type 1 (NAP1). METHODS: Adults who presented with diarrhoea over a period of 15 months were prospectively evaluated for CDAD using stool toxin enzyme immunoassay (EIA). Positive specimens were evaluated by PCR. Patient demographics, laboratory parameters and outcomes were analysed. RESULTS: CDAD was diagnosed in 59 (9.2%) of 643 patients (median age 39 years, IQR 30 - 55). Thirty-four (58%) were female. Recent antibiotic exposure was reported in 39 (66%), 27 (46%) had been hospitalised within 3 months, and 14 (24%) had concomitant inflammatory bowel disease (IBD). Nineteen (32%) had community-acquired CDAD (CA-CDAD). The annual incidence of hospital-acquired CDAD (HA-CDAD) was 8.7 cases/10 000 hospitalisations. Two cases of the hypervirulent strain NAP1 were identified. Seven (12%) patients underwent colectomy (OR 6.83; 95% CI 2.41 - 19.3). On logistic regression, only antibiotic exposure independently predicted for CDAD (OR 2.9; 95% CI 1.6 - 5.1). Three (16%) cases of CA-CDAD reported antibiotic exposure (v. 90% of HA-CDAD, p<0.0001). Twelve (86%) patients had concomitant IBD (p<0.0001 v. HA-CDAD). CA-CDAD was significantly associated with antibiotic exposure (OR 0.04, 95% CI 0.01 - 0.24) and IBD (OR 9.6, 95% CI 1.15 - 79.8). CONCLUSION: The incidence of HA-CDAD in the South African setting is far lower than that reported in the West. While antibiotic use was a major risk factor for HA-CDAD, CA-CDAD was not associated with antibiotic therapy. Concurrent IBD was a predictor of CA-CDAD.
dc.identifier.apacitationRajabally, N. M., Pentecost, M., Pretorius, G., Whitelaw, A., Mendelson, M., & Watermeyer, G. (2013). The Clostridium difficile problem: A South African tertiary institution's prospective perspective. <i>South African Medical Journal</i>, 103(3), 168 - 177. http://hdl.handle.net/11427/34914en_ZA
dc.identifier.chicagocitationRajabally, N M, M Pentecost, G Pretorius, A Whitelaw, M Mendelson, and G Watermeyer "The Clostridium difficile problem: A South African tertiary institution's prospective perspective." <i>South African Medical Journal</i> 103, 3. (2013): 168 - 177. http://hdl.handle.net/11427/34914en_ZA
dc.identifier.citationRajabally, N.M., Pentecost, M., Pretorius, G., Whitelaw, A., Mendelson, M. & Watermeyer, G. 2013. The Clostridium difficile problem: A South African tertiary institution's prospective perspective. <i>South African Medical Journal.</i> 103(3):168 - 177. http://hdl.handle.net/11427/34914en_ZA
dc.identifier.issn0038-2469
dc.identifier.ris TY - Journal Article AU - Rajabally, N M AU - Pentecost, M AU - Pretorius, G AU - Whitelaw, A AU - Mendelson, M AU - Watermeyer, G AB - BACKGROUND AND OBJECTIVES: The aim of this study is to report the incidence of Clostridium difficile-associated disease (CDAD) in a tertiary-care hospital in South Africa and to identify risk factors, assess patient outcomes and determine the impact of the hypervirulent strain of the organism referred to as North American pulsed-field type 1 (NAP1). METHODS: Adults who presented with diarrhoea over a period of 15 months were prospectively evaluated for CDAD using stool toxin enzyme immunoassay (EIA). Positive specimens were evaluated by PCR. Patient demographics, laboratory parameters and outcomes were analysed. RESULTS: CDAD was diagnosed in 59 (9.2%) of 643 patients (median age 39 years, IQR 30 - 55). Thirty-four (58%) were female. Recent antibiotic exposure was reported in 39 (66%), 27 (46%) had been hospitalised within 3 months, and 14 (24%) had concomitant inflammatory bowel disease (IBD). Nineteen (32%) had community-acquired CDAD (CA-CDAD). The annual incidence of hospital-acquired CDAD (HA-CDAD) was 8.7 cases/10 000 hospitalisations. Two cases of the hypervirulent strain NAP1 were identified. Seven (12%) patients underwent colectomy (OR 6.83; 95% CI 2.41 - 19.3). On logistic regression, only antibiotic exposure independently predicted for CDAD (OR 2.9; 95% CI 1.6 - 5.1). Three (16%) cases of CA-CDAD reported antibiotic exposure (v. 90% of HA-CDAD, p<0.0001). Twelve (86%) patients had concomitant IBD (p<0.0001 v. HA-CDAD). CA-CDAD was significantly associated with antibiotic exposure (OR 0.04, 95% CI 0.01 - 0.24) and IBD (OR 9.6, 95% CI 1.15 - 79.8). CONCLUSION: The incidence of HA-CDAD in the South African setting is far lower than that reported in the West. While antibiotic use was a major risk factor for HA-CDAD, CA-CDAD was not associated with antibiotic therapy. Concurrent IBD was a predictor of CA-CDAD. DA - 2013 DB - OpenUCT DP - University of Cape Town IS - 3 J1 - South African Medical Journal LK - https://open.uct.ac.za PY - 2013 SM - 0038-2469 T1 - The Clostridium difficile problem: A South African tertiary institution's prospective perspective TI - The Clostridium difficile problem: A South African tertiary institution's prospective perspective UR - http://hdl.handle.net/11427/34914 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34914
dc.identifier.vancouvercitationRajabally NM, Pentecost M, Pretorius G, Whitelaw A, Mendelson M, Watermeyer G. The Clostridium difficile problem: A South African tertiary institution's prospective perspective. South African Medical Journal. 2013;103(3):168 - 177. http://hdl.handle.net/11427/34914.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceSouth African Medical Journal
dc.source.journalissue3
dc.source.journalvolume103
dc.source.pagination168 - 177
dc.source.urihttps://dx.doi.org/10.7196/SAMJ.6012
dc.subject.otherAdult
dc.subject.otherAnti-Bacterial Agents
dc.subject.otherBacterial Typing Techniques
dc.subject.otherClostridium difficile
dc.subject.otherComorbidity
dc.subject.otherDiarrhea
dc.subject.otherEnterocolitis, Pseudomembranous
dc.subject.otherFemale
dc.subject.otherHospitalization
dc.subject.otherHumans
dc.subject.otherIncidence
dc.subject.otherInflammatory Bowel Diseases
dc.subject.otherLogistic Models
dc.subject.otherMale
dc.subject.otherMiddle Aged
dc.titleThe Clostridium difficile problem: A South African tertiary institution's prospective perspective
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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