Clostridium difficile infection at Charlotte Maxeke Johannesburg Academic Hospital
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Date
2016
Authors
Godinho, Lee-Anne
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Abstract
Background and objectives: In recent years, Clostridium difficile infection has become
more common and more resistant to therapy resulting in significant in-patient morbidity and
mortality. The aim of this study was to describe the characteristics of patients with
Clostridium difficile infection at the Charlotte Maxeke Johannesburg Academic Hospital
(CMJAH) in Johannesburg, South Africa.
Methods: This was a retrospective analysis of the records of 154 adult in-patients with
confirmed Clostridium difficile infection on stool samples during the period 1 January 2013
to 30 June 2014. Patient demographics, clinical presentation, risk factors, HIV status,
treatment, severity indicators and outcomes were analysed. Patients were catagorised as
having either healthcare-associated or community-acquired Clostridium difficile infections.
HIV-positive patients were compared with HIV-negative patients and the survivors were
compared with the non-survivors.
Results: Overall, 83 (53.8%) patients were female and the median age was 39 years
(Interquartile range: 31-52). The most common symptom was watery diarrhoea (92.9%)
followed by fever (27.3%). Overall, 145 (97.9%) patients had been exposed to antibiotics in
the last 30 days, 54 (35.1%) to immunosuppressives, 48 (31.2%) to gastric acid suppressants
and 65 (42.2%) patients had previous hospital admissions. In total 73 (47.4%) patients died.
Only two cases of community-acquired Clostridium difficile infections were identified. There
was no difference in outcomes of HIV-positive patients compared to HIV-negative patients.
The non-survivors tended to have a greater number of severity indicators compared to the
survivors.
Conclusion: Patients with Clostridium difficile infection in this study were younger than
expected with a higher mortality than that reported in the Western world. The number of
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community-acquired Clostridium difficile infections was less than reported in previous
studies.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine
in the branch of Internal Medicine
2016, Johannesburg