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Clostridium difficile: A healthcare-associated infection of unknown significance in adults in sub-Saharan Africa

Keeley, Alexander J, Beeching, Nicholas ORCID: https://orcid.org/0000-0002-7019-8791, Stott, Katharine E, Roberts, Paul, Watson, Alastair J and Beadsworth, Mike (2016) 'Clostridium difficile: A healthcare-associated infection of unknown significance in adults in sub-Saharan Africa'. Malawi Medical Journal.

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Abstract

Background
Clostridium difficile infection (CDI) causes a high burden of disease in high-resource healthcare systems, with significant morbidity, mortality, and financial implications. CDI is a healthcare-associated infection for which the primary risk factor is antibiotic usage, and it is the leading cause of bacterial diarrhoea in HIV-infected patients in the United States. Little is known about the disease burden of CDI in sub-Saharan Africa, where HIV and healthcare-associated infections are more prevalent and antibiotic usage is less restricted. This article reviews published literature on CDI in sub-Saharan Africa, highlighting areas for future research.

Methods
English language publications since 1995 were identified from online databases (PubMed, Medline, Google Scholar, and SCOPUS), using combinations of keywords “C. difficile”, “Africa”, and “HIV”.

Results
Ten relevant studies were identified. There was considerable variation in the methodologies used to assess for carriage of toxigenic C. difficile and its associations. Eight studies reported carriage of toxigenic C. difficile. Three (of three) studies found an association with antibiotic usage. One (of four) studies showed an association with HIV infection. One study showed no association with degree of immunosuppression in HIV. Two (of three) studies showed an association between carriage of toxigenic C. difficile and diarrhoeal illness.

Conclusions
While the carriage of toxigenic C. difficile is well described in sub-Saharan Africa, the impact of CDI in the region remains poorly understood and warrants further research.

Item Type: Article
Subjects: WA Public Health > WA 20.5 Research (General)
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WC Communicable Diseases > Infection. Bacterial Infections > Other Bacterial Infections. Zoonotic Bacterial Infections > WC 368 Clostridium infections
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): PMC5117103
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 27 Apr 2018 12:39
Last Modified: 09 Sep 2019 06:27
URI: https://archive.lstmed.ac.uk/id/eprint/6427

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