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

Area of Science:

• Infectious Diseases
• Gastroenterology
• Epidemiology

Background:

• Clostridium difficile-associated disease (CDAD) poses a significant healthcare challenge globally.
• Understanding local incidence and risk factors is crucial for effective management.
• The hypervirulent North American pulsed-field type 1 (NAP1) strain warrants investigation.

Purpose of the Study:

• To determine the incidence of CDAD in a South African tertiary-care hospital.
• To identify risk factors associated with CDAD, including hospital-acquired (HA-CDAD) and community-acquired (CA-CDAD).
• To assess patient outcomes and the impact of the NAP1 strain.

Main Methods:

• Prospective evaluation of adult patients with diarrhoea over 15 months.
• Diagnosis of CDAD using stool toxin enzyme immunoassay (EIA) and polymerase chain reaction (PCR).
• Analysis of patient demographics, laboratory parameters, outcomes, and risk factors including antibiotic exposure and inflammatory bowel disease (IBD).

Main Results:

• CDAD diagnosed in 9.2% of patients; HA-CDAD incidence was 8.7 cases/10,000 hospitalizations.
• Antibiotic exposure was an independent predictor of HA-CDAD (OR 2.9).
• CA-CDAD was associated with IBD (OR 9.6) and inversely associated with antibiotic exposure (OR 0.04). Two cases of the NAP1 strain were identified.

Conclusions:

• The incidence of HA-CDAD in South Africa is lower compared to Western countries.
• Antibiotic use is a primary risk factor for HA-CDAD.
• Community-acquired CDAD is significantly associated with inflammatory bowel disease and not typically linked to recent antibiotic therapy.