Clostridium difficile infection in Johannesburg, South Africa

ABSTRACT

Objectives: The incidence of Clostridium difficile infection is increasing, resulting in significant in-patient morbidity and mortality. We describe the characteristics of Clostridium difficile infection in patients admitted to a tertiary Academic Hospital in Johannesburg, South Africa.

Methods: This was a retrospective record review of 154 adult in-patients with confirmed Clostridium difficile infection undertaken between 1 January 2013 and 30 June 2014.

Results: Overall, 83 (53.9%) patients were female and the median age was 39 years. The most common symptoms were watery diarrhea (92.9%) and 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. Only two cases were community-acquired. In total, 73 (47.4%) patients died. There was no difference in outcomes of HIV-positive patients compared to HIV-negative patients; however, the clinical features were more marked in the HIV-negative patients. 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 and had a higher mortality than that reported in the Western world. Most infections were hospital-acquired.

KEYWORDS:

• Antibiotics
• Clostridium difficile
• health-care associated
• HIV infection
• mortality
• nosocomial
• outcome
• risk factors

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial relationships to disclose.

Additional information

Funding

This manuscript was not funded.