Cluster of Clostridium difficile at a TB hospital in the Eastern Cape, South Africa, 2016
Theesan Vedan1,&, Riyadh Manesen1
1National Institute for Communicable Disease, Johannesburg, South Africa
Theesan Vedan, National Institute for Communicable Disease, Johannesburg, South Africa
an increase in the number of Clostridium difficile infections was detected in a TB hospital in the Nelson Mandela Bay district, South Africa. We conducted an investigation to understand the epidemiology of C. difficile within the facility and identify opportunities for control.
a chart abstraction form was developed to collect patient clinical data. Stool specimens were cultured and tested by PCR for C. difficile. A walk-through of the affected wards was conducted to assess infection control (IC) practices.
in total, 8 laboratory confirmed cases were identified. The first diagnosed patient was transferred from another facility with diarrheal symptoms and tested positive for C. difficile on admission. The median age of affected patients was 43 years (range 25-71 years); 7 of 8 (87.5%) patients were HIV co-infected, and 2 patients (25%) died. The median interval from admission to the onset of symptoms was 22.5 days (range 0-103 days). Five of 8 patients (62.5%) had pulmonary TB (PTB), 2 had TB of the spine (25%) and 1 had TB meningitis (12.5%); 7 patients had drug resistant TB. The medical wards had the most number of cases (6), distributed equally among the male and female wards. The environmental investigation revealed inadequate IC practices, including lack of hand wash facilities, poor monitoring of health care workers, and substandard condition and location of isolation rooms. Seven patients were given Metronidazole, and 5 (71%) were treated concurrently with Vancomycin, for the diarrheal episode.
there was likely in-hospital transmission of C. difficile, compounded by inadequate IC practices, multiple antibiotic use, severe underlying medical conditions, and lengthy hospital stays. We recommended changing the chemical disinfectant to control spore forming bacteria, improvements in IC practices, limiting the number of attending health care workers, and adhering to recommended antibiotic treatment protocols.
1st Ghana Field Epidemiology and Laboratory Training Programme Scientific conference (Accra)
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