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Clostridioides difficile infection and testing rates in South Africa: A multicentre study, 2017-2020
Trusha Nana1, Praksha Ramjathan2, Khine Swe-Swe Han2
1Department of Clinical Microbiology, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Gauteng, 2193, South Africa; National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa.
Insights
Clostridioides difficile infection (CDI) rates varied significantly across three South African hospitals between 2017-2020. Testing practices also differed, with a notable CDI increase in 2020 during the SARS-CoV-2 outbreak.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- Clostridioides difficile infection (CDI) is a significant healthcare-associated infection.
- Surveillance of CDI rates and testing practices is crucial for effective management.
- Understanding variations in CDI epidemiology is essential for targeted interventions.
Purpose of the Study:
- To determine Clostridioides difficile infection (CDI) rates and testing practices.
- To compare CDI epidemiology across three tertiary/quaternary hospitals in South Africa (SA).
- To analyze trends from 2017 to 2020, including the impact of the SARS-CoV-2 outbreak.
Main Methods:
- Retrospective review of laboratory records for C. difficile testing.
- Analysis of clinical records to determine recurrent CDI (rCDI) rates.
- Data collected from Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Tygerberg Hospital (TBH), and Inkosi Albert Luthuli Central Academic Hospital (IALCH).
Main Results:
- Median primary CDI rates per 10,000 patient-days varied: 5.3 (CMJAH), 1.8 (TBH), and 0.3 (IALCH).
- All hospitals observed an increase in primary CDI rates in 2020 compared to 2019.
- Median testing rates per 10,000 patient-days also showed significant differences: 39 (CMJAH), 14 (TBH), and 4 (IALCH).
- Recurrent CDI (rCDI) rates were low, ranging from 2 to 5 per 100 incident episodes.
Conclusions:
- Significant disparities in CDI and testing rates exist among SA hospitals.
- The 2020 SARS-CoV-2 outbreak correlated with increased CDI rates across all studied centers.
- Systematic surveillance of healthcare-onset CDI in SA hospitals is recommended.
Objectives:
To describe Clostridioides difficile infection (CDI) rates and testing practices, at three tertiary/quaternary hospitals in South Africa (SA) for the period 2017 to 2020.
Methods:
A retrospective laboratory record review of all C. difficile testing at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Tygerberg Hospital (TBH) and Inkosi Albert Luthuli Central Academic Hospital (IALCH) was performed. Clinical records of patients with rCDI were reviewed to determine recurrent CDI (rCDI) rates.
Results:
The median primary CDI rates per 10 000 patient-days (PD) were 5.3 at CMJAH, 1.8 at TBH, and 0.3 at IALCH. In 2020, all hospitals reported an increase in primary CDI rates compared to 2019. The median testing rates per 10 000 PD were 39 at CMJAH, 14 at TBH, and 4 at IALCH. The median age of patients with primary CDI was 33 years (IQR: 22-45 years). The rCDI rates ranged from 2 to 5 per 100 incident episodes.
Conclusion:
Significant variations in CDI and testing rates were observed across the three hospitals. An increase in CDI rates was noted at all centres during the 2020 SARS-CoV-2 outbreak. Advanced age was not prevalent in the cohort, and rCDI rates were relatively low. These findings highlight the need for systematic surveillance of healthcare-onset CDI across SA hospitals.
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