Clostridioides difficile infection and testing rates in South Africa: A multicentre study, 2017-2020.

Objectives: To describe Clostridioides difficile infection (CDI) rates and testing practices, at three tertiary/quaternary hospitals in South Africa (SA) for the period 2017 to 2020.

Methods: A retrospective laboratory record review of all C. difficile testing at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Tygerberg Hospital (TBH) and Inkosi Albert Luthuli Central Academic Hospital (IALCH) was performed. Clinical records of patients with rCDI were reviewed to determine recurrent CDI (rCDI) rates.

Results: The median primary CDI rates per 10 000 patient-days (PD) were 5.3 at CMJAH, 1.8 at TBH, and 0.3 at IALCH. In 2020, all hospitals reported an increase in primary CDI rates compared to 2019. The median testing rates per 10 000 PD were 39 at CMJAH, 14 at TBH, and 4 at IALCH. The median age of patients with primary CDI was 33 years (IQR: 22-45 years). The rCDI rates ranged from 2 to 5 per 100 incident episodes.

Conclusion: Significant variations in CDI and testing rates were observed across the three hospitals. An increase in CDI rates was noted at all centres during the 2020 SARS-CoV-2 outbreak. Advanced age was not prevalent in the cohort, and rCDI rates were relatively low. These findings highlight the need for systematic surveillance of healthcare-onset CDI across SA hospitals.