Proceedings of 1st Ghana Field Epidemiology and Laboratory Training Programme Scientific conference (Accra, 2017)

Oral presentation

Cluster of Clostridium difficile at a TB hospital in the Eastern Cape, South Africa, 2016

Cite this: Pan African Medical Journal - Conference Proceedings. Nov 2017; 3(3): 119. doi:10.11604/pamj.cp.2017.3.119.471

Submitted: 30 Oct 17   Accepted: 30 Oct 17   Published: 01 Nov 17

Key words: Clostridium difficile, infection control practices, hospital

© Theesan Vedan et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.proceedings.panafrican-med-journal.com/conferences/2017/3/119/abstract

Corresponding author: Theesan Vedan, National Institute for Communicable Disease, Johannesburg, South Africa (theesan.vedan@gmail.com)

This abstract is published as part of the proceedings of 1st Ghana Field Epidemiology and Laboratory Training Programme Scientific conference (GHANA, )

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

 

 

&Corresponding author
Theesan Vedan, National Institute for Communicable Disease, Johannesburg, South Africa

 

 

Abstract

Introduction: 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.

 

Methods: 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.

 

Results: 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.

 

Conclusion: 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)

Country: GHANA

Dates: 18 Sep 17 - 21 Sep 17

Venue: Swiss Spirit and Suites Alisa Hotels

Organizers: Ghana Field Epidemiology and Laboratory Training Programme

Secretariat: gfeltp@gmail.com

Contact person: Dr. Ernest Kenu (ernest_kenu@yahoo.com)