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

• Published in: Malawi medical journal Vol. 28; no. 2; pp. 66 - 69
• Main Authors: Keeley, Alexander J, Beeching, Nicholas J, Stott, Katharine E, Roberts, Paul, Watson, Alastair J, Beadsworth, Michael Bj
• Format: Journal Article
• Language: English
• Published: Malawi The Medical Association Of Malawi 01-06-2016
• Subjects: Anti-Bacterial Agents - therapeutic use; Clostridium difficile; Clostridium Infections - diagnosis; Clostridium Infections - drug therapy; Clostridium Infections - microbiology; Clostridium Infections - prevention & control; Cross Infection - diagnosis; Cross Infection - drug therapy; Cross Infection - microbiology; Cross Infection - prevention & control; Diarrhea; Humans; Intestine, Large - microbiology; Review
• ISSN: 1995-7262; 1995-7270; 1995-7262
• DOI: 10.4314/mmj.v28i2.8

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.
English language publications since 1995 were identified from online databases (PubMed, Medline, Google Scholar, and SCOPUS), using combinations of keywords
, "Africa", and "HIV".
Ten relevant studies were identified. There was considerable variation in the methodologies used to assess for carriage of toxigenic
and its associations. Eight studies reported carriage of toxigenic
. 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
and diarrhoeal illness.
While the carriage of toxigenic
is well described in sub-Saharan Africa, the impact of CDI in the region remains poorly understood and warrants further research.