Infectious diseases consultations at a South African academic hospital: a six-month review of inpatient consultations
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Date
2019
Authors
Richards, Lauren Carol
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Abstract
ABSTRACT
Background
The infectious diseases (ID) department is becoming increasingly valuable in an era
of evolving antimicrobial resistance and an enlarging immunocompromised
population. To date, there has been little evaluation of the infectious diseases
consultation services in South African hospitals.
Methods
A review of ID inpatient consultations was performed over a period of six months at
Helen Joseph Hospital, a South African tertiary hospital. Data from each consultation
was recorded on a computerised database and analysed.
Results
A total of 749 ID consultations were reviewed representing an average of 4.8% of
hospital admissions. The most common reasons for consultation were for initiation of
antiretroviral therapy (ART) (27.8%), lipoarabinomannan antigen (LAM) testing
(24.8%) and change of ART (21.6%). Of all patients reviewed, 93.3% were human
immunodeficiency virus (HIV) positive and the median CD4 count was 52 cell/mm3.
The infectious diagnoses (excluding HIV) that were most frequently encountered
were pulmonary and abdominal tuberculosis (TB) and acute gastroenteritis. When all
subcategories of TB infection were combined, 42.9% of patients reviewed were found
to be infected with TB. The most common non-infectious co-morbidities were acute
kidney injury, hypertension and diabetes mellitus.
Conclusion
The ID department sees a high volume of cases. HIV, TB and their management
dominate the workload and the patient disease profile. Non-infectious comorbidities
were infrequent in this population, possibly due to the relatively young median age.
Due to the large numbers of HIV- and TB-related cases, only a small proportion of
the inpatient ID service was devoted to antibiotic stewardship, infection prevention
and control, and the spectrum of cases seen more frequently by ID departments in
the developed world.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in partial fulfillment for the requirements of the degree of
Master of Medicine in Internal medicine
Johannesburg 2019