Epidemiology of Clostridioides difficile in South Africa.

<h4>Background</h4>Clostridioides difficile (CD) is the most common healthcare-associated enteric infection. There is currently limited epidemiological evidence on CD incidence in South Africa.<h4>Aim</h4>To estimate the burden of CD infection (CDI) in the South African publi...

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Autores principales:	Pieter de Jager, Oliver Smith, Stefan Bolon, Juno Thomas, Guy A Richards
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e330dfac0f10433480b983b9c5a48b6d
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spelling	oai:doaj.org-article:e330dfac0f10433480b983b9c5a48b6d2021-12-02T20:16:12ZEpidemiology of Clostridioides difficile in South Africa.1932-620310.1371/journal.pone.0259771https://doaj.org/article/e330dfac0f10433480b983b9c5a48b6d2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0259771https://doaj.org/toc/1932-6203<h4>Background</h4>Clostridioides difficile (CD) is the most common healthcare-associated enteric infection. There is currently limited epidemiological evidence on CD incidence in South Africa.<h4>Aim</h4>To estimate the burden of CD infection (CDI) in the South African public sector between 1 July 2016 and 30 June 2017.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.Pieter de JagerOliver SmithStefan BolonJuno ThomasGuy A RichardsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11, p e0259771 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Pieter de Jager Oliver Smith Stefan Bolon Juno Thomas Guy A Richards Epidemiology of Clostridioides difficile in South Africa.
description	<h4>Background</h4>Clostridioides difficile (CD) is the most common healthcare-associated enteric infection. There is currently limited epidemiological evidence on CD incidence in South Africa.<h4>Aim</h4>To estimate the burden of CD infection (CDI) in the South African public sector between 1 July 2016 and 30 June 2017.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.
format	article
author	Pieter de Jager Oliver Smith Stefan Bolon Juno Thomas Guy A Richards
author_facet	Pieter de Jager Oliver Smith Stefan Bolon Juno Thomas Guy A Richards
author_sort	Pieter de Jager
title	Epidemiology of Clostridioides difficile in South Africa.
title_short	Epidemiology of Clostridioides difficile in South Africa.
title_full	Epidemiology of Clostridioides difficile in South Africa.
title_fullStr	Epidemiology of Clostridioides difficile in South Africa.
title_full_unstemmed	Epidemiology of Clostridioides difficile in South Africa.
title_sort	epidemiology of clostridioides difficile in south africa.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/e330dfac0f10433480b983b9c5a48b6d
work_keys_str_mv	AT pieterdejager epidemiologyofclostridioidesdifficileinsouthafrica AT oliversmith epidemiologyofclostridioidesdifficileinsouthafrica AT stefanbolon epidemiologyofclostridioidesdifficileinsouthafrica AT junothomas epidemiologyofclostridioidesdifficileinsouthafrica AT guyarichards epidemiologyofclostridioidesdifficileinsouthafrica
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Epidemiology of Clostridioides difficile in South Africa.

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