Epidemiology and outcomes of infection among hospitalised patients: results of a multicentre retrospective study in South Africa.

INTRODUCTION

Limited data exist on infection (CDI) in low-resource settings and settings with high prevalence of HIV. We aimed to determine baseline CDI patient characteristics and management and their contribution to mortality.

METHODS

We reviewed adult patients hospitalised with diarrhoea and a test result in 2015 from four public district hospitals in the Western Cape, South Africa. The primary outcome measures were risk factors for mortality. Secondary outcomes were risk factors (positive vs negative) and CDI treatment.

RESULTS

Charts of patients with diarrhoea tested for (n=250; 112 positive, 138 negative) were reviewed. The study population included more women (65%). positive patients were older (46.5 vs 40.7 years, p<0.01). All-cause mortality was more common in the positive group (29% vs 8%, p<0.0001; HR 2.0, 95% CI 1.1 to 3.6). Tuberculosis ( positive 54% vs negative 32%, p<0.001), 30-day prior antibiotic exposure ( positive 83% vs negative 46%, p<0.001) and prior hospitalisation ( positive 55% vs negative 22%, p<0.001) were also more common in the positive group. positive test result (OR 4.7, 95% CI 2.0 to 11.2; p<0.001), male gender (OR 2.8, 95% CI 1.1 to 7.2; p=0.031) and tuberculosis (OR 2.3, 95% CI 1.0 to 5.0; p=0.038) were independently associated with mortality. Of patients starting treatment, metronidazole was the most common antimicrobial therapy initiated (70%, n=78); 32 positive (29%) patients were not treated.

CONCLUSION

Patients testing positive for are at high risk of mortality at public district hospitals in South Africa. Tuberculosis should be considered an additional risk factor for CDI in populations with high tuberculosis and HIV comorbidity. Interventions for CDI prevention and management are urgently needed.