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Almutairi MS, Alnezary FS, Alsuwaylim RO, Alsulaymi I, Almohammed OA, Thabit AK. Assessment of Knowledge and Practice of Healthcare Providers in Saudi Arabia Regarding Clostridioides difficile Infection Diagnosis and Management: A Cross-Sectional Questionnaire-Based Study. Infect Drug Resist 2024; 17:583-594. [PMID: 38375099 PMCID: PMC10875178 DOI: 10.2147/idr.s450281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Diagnosis of Clostridioides difficile infection (CDI) depends on clinical presentation and laboratory testing. Stool diagnostic tests are essential for effective detection of toxigenic C. difficile strains. No study to date has evaluated the readability of microbiology labs in Saudi Arabia to test for CDI and evaluated the knowledge and practice of healthcare providers regarding CDI management. Therefore, this study aimed to assess the knowledge and practice of healthcare providers in Saudi Arabia regarding CDI diagnosis and treatment. Methods A cross-sectional, descriptive, questionnaire-based study was conducted on healthcare providers in Saudi Arabia, primarily physicians and clinical pharmacists. The questionnaire was developed based on a literature review and input from infectious diseases experts. The questionnaire was administered online. Data were analyzed using descriptive and inferential statistics. Results Of 183 respondents, 27.9% had adequate knowledge on CDI diagnosis and management. The majority were internal medicine specialists (37.7%) working in governmental or semi-governmental hospitals (80.9%) in central (46.6%) or southern (30.1%) regions of Saudi Arabia. Most participants assessed laxative use (86.3%) and reported positive C. difficile specimens to infection control (67.2%). However, knowledge varied, with 57.4% supporting unnecessary retesting and 53% assuming positive PCR test indicates moderate CDI probability. Factors such as specialization, hospital accreditation status, and bed capacity influenced knowledge levels (p<0.01 for all factors). Conclusion The study revealed a significant knowledge gap among Saudi healthcare providers regarding CDI diagnosis, management, and severity classification, highlighting the need for improved education and adherence to guidelines to improve patient outcomes and reduce recurrence risks.
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Affiliation(s)
- Masaad Saeed Almutairi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Faris S Alnezary
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Rasil O Alsuwaylim
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Ibrahim Alsulaymi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Omar A Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abrar K Thabit
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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Effect of Online Instruction on the Level of Knowledge About Clostridium difficile Infection Among Undergraduate Nursing Students in a Developing Country. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Comparcini D, Simonetti V, Segala FV, Di Gennaro F, Bavaro DF, Pompeo MA, Saracino A, Cicolini G. Nurses’ Knowledge, Attitudes and Practices on the Management of Clostridioides difficile Infection: A Cross-Sectional Study. Antibiotics (Basel) 2023; 12:antibiotics12030529. [PMID: 36978396 PMCID: PMC10044176 DOI: 10.3390/antibiotics12030529] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
Clostridioides difficile is, worldwide, the leading cause of hospital-acquired infection. Outbreaks are largely related to antibiotic exposure and contact contamination, but little is known about C. difficle infection (CDI) awareness in the nurse population. We conducted a cross-sectional survey to study Italian nurses, based on CDI guidelines. We recruited 200 nurses working in 14 Italian hospitals. Using a one-way analysis of variance of knowledge scores, female nurses (mean 9.67 (standard deviation ± 1.63), p = 0.03), and nurses with a higher level of university education (mean 9.79 (SD ± 1.67), p = 0.04) were demonstrated to have better knowledge about CDI. In addition, 92.5% (n = 184) of the sample declared that they did not have specific postgraduate training about CDI. Seventy-four percent (n = 149) of the respondents declared that they used procedures, protocols and guidelines about CDI in their workplace, but only 46.5% (n = 93) reported using C. difficile-specific bundles during their daily practice. In conclusion, our study highlights a lack of knowledge concerning CDI clinical guidelines among Italian nurses.
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Affiliation(s)
- Dania Comparcini
- CdL Infermieristica di Ancona, Facoltà Medicina e Chirurgia, Università Politecnica delle Marche (Univpm), 60121 Ancona, Italy
| | - Valentina Simonetti
- Dipartimento di Medicina e Chirurgia, LUM “Giuseppe Degennaro”, 70121 Bari, Italy
| | - Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70121 Bari, Italy
- Correspondence:
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Davide Fiore Bavaro
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70121 Bari, Italy
| | | | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Giancarlo Cicolini
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70121 Bari, Italy
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Finnimore K, Smyth W, Carrucan J, Nagle C. Nurses' knowledge, practices and perceptions regarding Clostridioides difficile: Survey results. Infect Dis Health 2023; 28:39-46. [PMID: 36002370 DOI: 10.1016/j.idh.2022.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/29/2022] [Accepted: 07/19/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) can cause patients debilitating symptoms, places additional demands on nurses' and midwives' and is increasingly prevalent. Understanding the knowledge base of nurses caring for patients with CDI may contribute to improving care practices. METHODS A cross-sectional anonymous survey across our Hospital and Health Services was conducted. Descriptive statistics and thematic analysis techniques were used to analyse, summarise, and report data. RESULTS A total of 198 completed surveys by nurses were included in the analysis. Most respondents (73.2%) could not recall having any recent CDI education. Nearly all agreed that CDI is an important infection control issue (80. 8%), and that CDI education was important (94.9%). Knowledge of the potentially fatal outcome of CDI was not well known with only 53% responding correctly to this question. Respondents were confident in fundamental infection control precautions of patient placement (93.4%) and environmental cleaning (86.4%). Knowledge of the microbiological aspects of CDI were less well known. The impact to workload and the additional burden of caring for patients with CDI was evident in the overwhelming response (83%) to the two open-ended questions about what makes it "easy" and what make it "hard" to implement infection control strategies for CDI patients. CONCLUSION Respondents identified many factors that could contribute to less-than optimal care and management of inpatients with CDI, and identified some solutions that would facilitate the provision of best practice. An educational intervention, with emphasis on the areas of greatest knowledge deficits, has been developed.
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Affiliation(s)
- Kara Finnimore
- Infection Prevention and Control, Townsville Hospital and Health Service, Townsville University Hospital, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia; Safety, Quality and Innovation Unit, Sunshine Coast Hospital and Health Service, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, Queensland 4575, Australia.
| | - Wendy Smyth
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia; Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland 4811, Australia
| | - Janine Carrucan
- Infection Prevention and Control, Townsville Hospital and Health Service, Townsville University Hospital, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia
| | - Cate Nagle
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia; Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland 4811, Australia
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Legenza L, Coetzee R, Rose WE, Esack T, Crombie K, Mina M, Safdar N, Barnett SG. Application of consolidated framework for implementation research to improve Clostridioides difficile infection management in district hospitals. Res Social Adm Pharm 2022; 18:4100-4111. [PMID: 35981939 PMCID: PMC9891768 DOI: 10.1016/j.sapharm.2022.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 06/08/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) contributes the global threats of drug resistant infections, healthcare acquired infections and antimicrobial resistance. Yet CDI knowledge among healthcare providers in low-resource settings is limited and CDI testing, treatment, and infection prevention measures are often delayed. OBJECTIVES to develop a CDI intervention informed by the local context within South African public district level hospitals, and analyze the CDI intervention and implementation process. METHODS A CDI checklist intervention was designed and implemented at three district level hospitals in the Western Cape, South Africa that volunteered to participate. Data collection included a retrospective medical records review of patients hospitalized with C. difficile test orders during the 90 days post-implementation. Patient outcomes and checklist components (e.g. antibiotics) were collected. Qualitative interviews (n = 14) and focus groups (n = 6) were conducted with healthcare providers on-site. The Consolidated Framework for Implementation Research (CFIR) and the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) were applied to collected data and observations in order to identify drivers and barriers to implementation and understand differences in uptake. RESULTS One of the three hospitals displayed high intervention uptake. Highly relevant CFIR constructs linked to intervention uptake included tension for change, strong peer intervention champions, champions in influential leadership positions, and the intervention's simplicity (CFIR construct: complexity). Tension for change, a recognized need to improve CDI identification and treatment, at the high uptake hospital was also supported by an academic partnership for antimicrobial stewardship. CONCLUSIONS This research provides a straight-forward health systems strengthening intervention for CDI that is both needed and uncomplicated, in an understudied low resource setting. Intervention uptake was highest in the hospital with tension for change, influential champions, and existing academic partnerships. Implementation in settings with fewer academic connections requires further testing of collaborative implementation strategies and proactive adaptations.
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Affiliation(s)
- Laurel Legenza
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States; University of the Western Cape School of Pharmacy, Robert Sobukwe, Cape Town, 7535, South Africa.
| | - Renier Coetzee
- University of the Western Cape School of Pharmacy, Robert Sobukwe, Cape Town, 7535, South Africa; University of the Western Cape School of Public Health, Robert Sobukwe, Cape Town, 7535, South Africa
| | - Warren E Rose
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States
| | - Tasneem Esack
- Victoria Hospital, Wynberg, Cape Town, 7800, South Africa
| | - Kenneth Crombie
- University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - Megan Mina
- University of Cape Town, Rondebosch, Cape Town, 7700, South Africa; General Justice Gizenga Mpanza Regional Hospital, KwaDukuza, KwaZulu-Natal, 4450, South Africa
| | - Nasia Safdar
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, United States
| | - Susanne G Barnett
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States
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Kullin B, Abratt VR, Reid SJ, Riley TV. Clostridioides difficile infection in Africa: A narrative review. Anaerobe 2022; 74:102549. [PMID: 35337974 DOI: 10.1016/j.anaerobe.2022.102549] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 12/12/2022]
Abstract
Clostridioides (Clostridium) difficile infection (CDI) places a burden on healthcare facilities worldwide. Most research studies have been concentrated in high-income countries in North America, Europe, Asia and Australia, where C. difficile is the leading cause of diarrhoea associated with antimicrobial use. This narrative review summarises African CDI studies, focussing on reports published in the last 20 years. Although relatively sparse, the data suggest that CDI is an important cause of diarrhoea on the continent. African CDI patient populations are often younger than in European and North American settings, probably due to the high prevalence of co-morbid conditions such as tuberculosis, particularly in sub-Saharan Africa. Strain typing data are rare and where reported generally limited to single sites and institutions. Despite challenges, including a lack of facilities and awareness, there is a need for further investigation to more accurately determine the true burden of disease caused by C. difficile in Africa.
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Affiliation(s)
- Brian Kullin
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Valerie R Abratt
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Sharon J Reid
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Thomas V Riley
- Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, Western Australia WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Department of Microbiology, PathWest Laboratory Medicine, Nedlands, WA, Australia; School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia.
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de Jager P, Smith O, Bolon S, Thomas J, Richards GA. Epidemiology of Clostridioides difficile in South Africa. PLoS One 2021; 16:e0259771. [PMID: 34813626 PMCID: PMC8610264 DOI: 10.1371/journal.pone.0259771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 10/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background Clostridioides difficile (CD) is the most common healthcare-associated enteric infection. There is currently limited epidemiological evidence on CD incidence in South Africa. Aim To estimate the burden of CD infection (CDI) in the South African public sector between 1 July 2016 and 30 June 2017. Methods A retrospective cohort study utilizing secondary data was conducted to describe the epidemiology of CD in South Africa. We assessed the patient-level association between variables of interest, CD, and CD recurrence, by undertaking both univariate and multivariable analysis. Adjusted incidence rate ratios (aIRR) were calculated utilizing multivariable Poisson regression. The incidence of CD, CD recurrence and CD testing was estimated by Poisson regression for various levels of care and provinces. Results A total of 14 023 samples were tested for CD during the study period. After applying exclusion criteria, we were left with a sample of 10 053 of which 1 860 (18.50%) tested CD positive. A positive and significant association between CDI and level of care is found, with patients treated in specialized tuberculosis (TB) hospitals having a five-fold increased adjusted incidence risk ratio (aIRR) for CDI (aIRR 4.96 CI95% 4.08–6.04,) compared to those managed in primary care. Patients receiving care at a secondary, tertiary, or central hospital had 35%, 66% and 41% increased adjusted incidence of CDI compared to those managed in primary care, respectively. National incidence of CDI is estimated at 53.89 cases per 100 000 hospitalizations (CI95% 51.58–56.29), the incidence of recurrence at 21.39 (CI95% 15.06–29.48) cases per 1 000 cases and a recurrence rate of 2.14% (CI95% 1.51–2.94). Conclusion Compared to European countries, we found a comparable incidence of CD. However, our estimates are lower than those for the United States. Compared to high-income countries, this study found a comparatively lower CD recurrence.
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Affiliation(s)
- Pieter de Jager
- Department of Anesthesiology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Anesthesiology and Pain Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- * E-mail:
| | - Oliver Smith
- Department of Anaesthesiology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefan Bolon
- Department of Anaesthesiology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Juno Thomas
- Head of Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Sandringham, Johannesburg, South Africa
| | - Guy A. Richards
- Division of Critical Care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Porter GJ, Owens S, Breckons M. A systematic review of qualitative literature on antimicrobial stewardship in Sub-Saharan Africa. Glob Health Res Policy 2021; 6:31. [PMID: 34412692 PMCID: PMC8377884 DOI: 10.1186/s41256-021-00216-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a major problem in every region of the globe and Sub-Saharan Africa (SSA) is no exception. Several systematic reviews have addressed the prevalence of resistant organisms but few have examined the underlying causes in this region. This systematic review of qualitative literature aims to highlight barriers and facilitators to antimicrobial stewardship in SSA. METHODS A literature search of Embase and MEDLINE(R) was carried out. Studies were included if they were in English, conducted in SSA, and reported qualitative data on the barriers and facilitators of antimicrobial stewardship or on attitudes towards resistance promoting behaviours. Studies were screened with a simple critical appraisal tool. Secondary constructs were extracted and coded into concepts, which were then reviewed and grouped into themes in light of the complete dataset. RESULTS The literature search yielded 169 results, of which 14 studies from 11 countries were included in the final analysis. No studies were excluded as a result of the critical appraisal. Eight concepts emerged from initial coding, which were consolidated into five major themes: ineffective regulation, health system factors, clinical governance, patient factors and lack of resources. The ineffective regulation theme highlighted the balance between tightening drugstore regulation, reducing over-the-counter sale of antibiotics, and maintaining access to medicines for rural communities. Meanwhile, health system factors explored the tension between antimicrobial stewardship and the need of pharmacy workers to maintain profitable businesses. Additionally, a lack of resources, actions by patients and the day-to-day challenges of providing healthcare were shown to directly impede antimicrobial stewardship and exacerbate other factors which promote resistance. CONCLUSION Antibiotic resistance in SSA is a multi-faceted issue and while limited resources contribute to the problem they should be viewed in the context of other factors. We identify several contextual factors that affect resistance and stewardship that should be considered by policy makers when planning interventions. This literature base is also incomplete, with only 11 nations accounted for and many studies being confined to regions within countries, so more research is needed. Specifically, further studies on implementing stewardship interventions, successful or not, would be beneficial to inform future efforts.
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Affiliation(s)
- George James Porter
- Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle Upon Tyne, UK.
| | - Stephen Owens
- Department of Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Framlington Place, Newcastle Upon Tyne, UK
| | - Matthew Breckons
- Population Health Sciences Institute, Newcastle University, Framlington Place, Newcastle Upon Tyne, UK
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Doll M, Marra AR, Apisarnthanarak A, Al-Maani AS, Abbas S, Rosenthal VD. Prevention of Clostridioides difficile in hospitals: A position paper of the International Society for Infectious Diseases. Int J Infect Dis 2020; 102:188-195. [PMID: 33122100 DOI: 10.1016/j.ijid.2020.10.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023] Open
Abstract
Clostridioides difficile infection is an increasing presence worldwide. Prevention is multipronged, reflecting a complex and evolving epidemiology. Multiple guidelines exist regarding the prevention of C. difficile infection in healthcare settings; however, existing guidelines do not address C. difficile in low- and middle-income countries (LMIC). Nevertheless, the prevalence of C. difficile in LMIC likely parallels, if not exceeds, that of high-income countries, and LMIC may experience additional challenges in C. difficile diagnosis and control. A panel of experts was convened by the International Society for Infectious Diseases (ISID) to review the current state of C. difficile infections globally and make evidence-based recommendations for infection prevention that are broadly applicable.
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Affiliation(s)
- Michelle Doll
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Alexandre R Marra
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Amal Saif Al-Maani
- Department of Infection Control and Prevention, Ministry of Health, Muscat, Oman
| | - Salma Abbas
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Victor D Rosenthal
- International Nosocomial Infection Control Consortium (INICC), Buenos Aires, Argentina
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Djuikoue IC, Tambo E, Tazemda G, Njajou O, Makoudjou D, Sokeng V, Wandji M, Tomi C, Nanfack A, Dayomo A, Lacmago S, Tassadjo F, Sipowo RT, Kakam C, Djoko AB, Assob CN, Andremont A, Barbut F. Evaluation of inpatients Clostridium difficile prevalence and risk factors in Cameroon. Infect Dis Poverty 2020; 9:122. [PMID: 32867842 PMCID: PMC7457802 DOI: 10.1186/s40249-020-00738-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 08/11/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Clostridium difficile, rarely found in hospitals, is a bacterium responsible for post-antibiotic diarrhea and Pseudomembranous Colitis (CPM). C. difficile selective pressure represents potential public health problem due to the production of toxins A and B serious pathologies effects/consequences. A transversal and analytic study was to assess the risk factors of C. difficile infection and to determine the prevalence of C. difficile in patients received in randomly selected five hospitals in Yaoundé, Cameroon. METHODS A total of 300 stool samples were collected from consented patients using a transversal and analytic study conducted from 10th July to 10th November 2018 in five hospitals in Cameroon. The detection or diagnostic kit was CerTest C. difficile Glutamate Dehydrogenase + Toxin A + Toxin B based on immuno-chromatographic assay. A univariate and multivariate analysis allowed us to highlight the associated factors. RESULTS The results showed a prevalence of C. difficile of 27.33% (82/300 stool patients'samples taken). Of these 27.33%, the production of Toxin A and Toxin B were 37.80 and 7.31% respectively. In univariate analysis, hospitalization was a significant (P = 0.01) risk factor favoring C. difficile infection. In multivariate analysis, corticosteroids and quinolones use/administration were significantly (adjusted Odd Ratio, aOR = 14.09, 95% CI: 1.62-122.54, P = 0.02 and aOR = 3.39, 95% CI: 1.00-11.34, P = 0.05 respectively) risk factor for this infection. CONCLUSION The prevalence of C. difficile infections (CDI) remain high in these settings and may be related not only to permanent steroids and antibiotics. Promoting education to both medical staff and patients on the prevalence and public health impact of C. difficile can be core inimproving rationale prescription of steroids and antibiotics to patients and promote human health and exponential growth in Cameroon.
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Affiliation(s)
- Ingrid Cécile Djuikoue
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
- Prevention and Control Foundation, Bangangte, Cameroon
| | - Ernest Tambo
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
- Prevention and Control Foundation, Bangangte, Cameroon
| | - Gildas Tazemda
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Omer Njajou
- Prevention and Control Foundation, Bangangte, Cameroon
| | - Denise Makoudjou
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Vanessa Sokeng
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Morelle Wandji
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Charlène Tomi
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | | | - Audrey Dayomo
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Suzie Lacmago
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Falubert Tassadjo
- Laboratoire de Bactériologie du Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Raissa Talla Sipowo
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | | | - Aicha Bibiane Djoko
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | | | - Antoine Andremont
- Faculty of Medicine, Xavier-Bichat Campus, University of Paris VII – Denis Diderot, Paris, France
| | - Frédéric Barbut
- Faculty of Pharmacy, Paris – University of Paris Descartes, Paris, France
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