Clostridium difficile infection at Charlotte Maxeke Johannesburg Academic Hospital

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 iv

community-acquired Clostridium difficile infections was less than reported in previous studies.