Clostridium difficile in stool samples in an academic hospital's intensive care and high care unit

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dc.contributor.authorBotha, Amorie
dc.date.accessioned2018-08-14T13:40:36Z
dc.date.available2018-08-14T13:40:36Z
dc.date.issued2018
dc.descriptionA research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Anaesthesiology, Johannesburg, 2018en_ZA
dc.description.abstractClostridium difficile is the most common causal pathogen for both antibiotic associated and nosocomial infectious diarrhoea. Clostridium difficile infection (CDI) in the intensive care unit (ICU) contributes to higher mortality and increased length of hospital stay. Institutional knowledge regarding CDI occurrence and management has the potential to improve management of CDI. The aim of this study was to determine the positive yield and number of NAP1 strains of all stool samples sent for Clostridium difficile testing from 576 ICU and 579 high care unit (HCU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) from 1 January 2014 until 31 December 2015. A retrospective, descriptive, contextual design was followed in this study. Data from the National Health Laboratory Services (NHLS) and patients’ clinical records were reviewed. A total number of 283 samples from 576 ICU and 579 HCU from 1 January 2014 until 31 December 2015 were included in this study. Of these samples 38 (13.42%) tested positive for Clostridium difficile. Out of the total number of 3 941patients admitted in 576 ICU and 579 HCU from 1 January 2014 until 31 December 2015, 38 (0.96%) samples from 26 individual patients (0.66%) sent for Clostridium difficile tests were positive. The median time from onset of diarrhoea until a stool sample was received in the laboratory was two days. The median time until reported diagnosis for Clostridium difficile polymerase chain reaction (PCR) was five hours and 23 hours for Clostridium difficile toxin enzyme immunoassay (EIA) test. The time difference was significant. The median time from onset of diarrhoea until treatment was initiated was 40 hours. In this study 24 patients (20%) received empiric treatment. Of the 43 patients who were started on treatment 28 (65.12%) were started on both oral and intravenous metronidazole. The median APACHE II score of 22 for CDI positive patients was significantly higher compared to the median APACHE II score of three for CDI negative patients. The APACHE II scores for patients who tested positive for Clostridium difficile were significantly higher than those who tested negative (p < 0.0001). This study concluded that 13.42% of samples sent for CDI tests were positive and the CDI positive patients had significantly higher APACHE II scores. A significant turnaround time difference between the Clostridium difficile PCR and EIA was also demonstrated. Institutional knowledge of the burden of disease of CDI as well as current practice can aid in better clinical decision making and improve patient outcome.en_ZA
dc.description.librarianXL2018en_ZA
dc.identifier.urihttps://hdl.handle.net/10539/25357
dc.language.isoenen_ZA
dc.subject.meshClostridium Difficile
dc.subject.meshIntensive Care Units
dc.titleClostridium difficile in stool samples in an academic hospital's intensive care and high care uniten_ZA
dc.typeThesisen_ZA
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