Abstract
BackgroundDiarrhoea due to Clostridium difficile infection (CDI) poses a significant burden on healthcare systems around the world. However, there are few reports on the current status of the disease in sub-Saharan Africa.ObjectivesThis study examined the occurrence of CDI in a South African population of tuberculosis patients, as well as the molecular epidemiology and antibiotic susceptibility profiles of C. difficile strains responsible for disease.MethodsToxigenic C. difficile in patients with suspected CDI attending two specialist tuberculosis hospitals in the Cape Town area were detected using a PCR-based diagnostic assay (Xpert® C. difficile). C. difficile strains isolated from PCR-positive specimens were characterised by ribotyping, multilocus variable-number tandem-repeat analysis and antibiotic susceptibility testing.ResultsThe period prevalence of CDI was approximately 70.07 cases per 1000 patient admissions. Strains belonging to ribotype 017 (RT017) made up over 95% of the patient isolates and all of them were multi-drug resistant. Multilocus variable-number tandem-repeat analysis revealed several clusters of highly related C. difficile RT017 strains present in tuberculosis patients in several wards at each hospital.ConclusionTuberculosis patients represent a population that may be at an increased risk of developing CDI and, in addition, may constitute a multi-drug resistant reservoir of this bacterium. This warrants further investigation and surveillance of the disease in this patient group and other high-risk patient groups in sub-Saharan Africa.
Highlights
Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhoea in the developed world, with complications of the disease, including potentially life-threatening pseudomembranous colitis and toxic megacolon.[1]
The presence of a relatively large number of multi-drug resistant (MDR) RT017 C. difficile strains in patients attending specialist tuberculosis hospitals in Cape Town is noteworthy, especially given their potential to cause outbreaks
Many of the isolates were closely related by multilocus variable-number tandem-repeat analysis (MLVA), and there is some evidence to suggest that patient-to-patient transfer of strains took place during the study period
Summary
Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhoea in the developed world, with complications of the disease, including potentially life-threatening pseudomembranous colitis and toxic megacolon.[1]. The most common of these is a subset of strains that produce only one functional toxin (TcdB) and is mainly comprised of members of the RT017 group. This group is widespread in Asia[9] and is capable of causing severe disease across diverse populations.[6]. There are few reports on the current status of the disease in sub-Saharan Africa
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