To ascertain the prevalence of clostridium difficile infection in cohort of HIV positive patients with diarrhoea at Chris Hani Baragwanath academic hospital
Shabangu, Thulisani Phillipine
Clostridium difficile infection (CDI) affects the digestive system; the symptoms range from mild to severe. In healthy individuals CDI is asymptomatic; however certain antibiotics and other medication can disturb the normal gut flora predisposing to CDI. This may lead to unnecessary hospitalisation or a prolonged hospital stay, which can be more debilitating in immunocompromised patients. Thus, judicious antibiotic use is crucial; however certain conditions require treatment that may alter normal flora, which is a predisposing factor for CDI. Objective: To ascertain the prevalence of Clostridium difficile infection in a cohort of HIV positive patients with diarrhoea at Chris Hani Baragwanath Academic Hospital. (CHBAH) over a 12 month period. Design: This was a prospective study. Methods: Prospective study, at CHBAH 200 HIV positive patients with diarrhoea were evaluated. Clinical records of the selected patients were accessed. A questionnaire was used to identify risk factors for Clostridium difficile infection (CDI) in the selected patients. Stool analysis was used to diagnose CDI. Results: Fifty-three patients (26.5%) had CDI. The most significant factors associated with an increased risk for CDI were: Anti-tuberculous treatment; most likely Rifampicin Antibiotic use, especially penicillin based drugs; clindamycin and carbapenems. A very low CD4 count was not a strong predictor for CDI (p=0.62) after adjusting for confounders (Viral load, concurrent co-morbid disease, use of antibiotics and anti-tuberculosis drugs). Conclusions: In our cohort of 200 patients, fifty-three (26.5%) had CDI. The risk factors identified were use of anti- TB drugs, common antibiotics associated with C.difficile.
A research report submitted to the faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of requirement for degree of Master of Medicine in Internal Medicine