A groundbreaking study by the University of the Western Cape (UWC) and the University of Wisconsin-Madison in the USA represents a crucial step towards better understanding and managing Clostridioides difficile infection (CDI), a life-threatening bacterial colon infection.
The study is especially critical for resource-constrained settings such as South Africa. Laurel Legenza is a researcher at the University of Wisconsin-Madison who recently received her PhD at UWC. Her work will undoubtedly shape healthcare practices and improve patient outcomes.
It sheds light on the urgent global health threat posed by CDI associated with devastating outbreaks, high costs, complications, readmissions, and even death.
The study was conducted for South Africa and will address gaps in low-resource settings.
While CDI has been extensively studied in high-resource environments, there has been a lack of research applicable to low-resource settings like South Africa. Legenza’s research focused on patient outcomes in secondary hospitals within the public healthcare sector. Her findings, which have been approved for implementation at healthcare facilities, are poised to make a significant impact on the country’s health system.
In the key findings of Legenza’s study, she provided a retrospective review of patients tested for the condition across four public district hospitals in the greater Cape Town metropole. Notably, she identified a novel risk factor for CDI: tuberculosis.
In a population with high tuberculosis and HIV comorbidity, tuberculosis emerged as an additional risk factor. Patients testing positive for C. difficile faced significantly higher mortality rates compared to those testing negative with diarrhoea (29% vs. 8%, p<0.0001).
The study also influenced treatment recommendations. While most patients received medication as a standard prescription (metronidazole), Legenza’s research supported considering vancomycin as an alternative in populations with a high prevalence of tuberculosis and immunocompromising conditions.
Additionally, her study revealed knowledge gaps among healthcare providers regarding CDI identification, diagnosis, treatment, and prevention. The resulting intervention package included a CDI checklist and provider education.
She said: “Implementing change is never easy. However, one of the three hospitals displayed high intervention uptake. Factors contributing to successful implementation included tension for change, strong peer intervention champions, influential leadership positions, and the intervention’s simplicity. Proactive adaptations to the champions’ strategy facilitated the process.”
An academic partnership for antimicrobial stewardship further supported the need for improved CDI identification and treatment. Legenza’s dissertation contributes valuable baseline data on CDI epidemiology, treatment, and outcomes. It also highlights facilitators and barriers to CDI care. The contextualised CDI intervention, informed by her results, has implications for pharmacy, health systems strengthening, infectious diseases, and implementation science. Most importantly, it underscores the urgent need for intervention, as CDI-associated mortality remains a significant risk for patients in South Africa.
