High morbidity and mortality of Clostridium difficile infection and its associations with ribotype 002 in Hong Kong. Issue 2 (August 2016)

• Record Type: Journal Article
• Authors: Wong, Sunny H.; Ip, Margaret; Hawkey, Peter M.; Lo, Norman; Hardy, Katie; Manzoor, Susan; Hui, Wyman W.M.; Choi, Kin-wing; Wong, Rity Y.K.; Yung, Irene M.H.; Cheung, Catherine S.K.; Lam, Kelvin L.Y.; Kwong, Thomas; Wu, William K.K.; Ng, Siew C.; Wu, Justin C.Y.; Sung, Joseph J.Y.; Lee, Nelson
• Is Part Of: Journal of infection. Volume 73:Issue 2(2016)
• Page Start: 115
• Page End: 122
• Publication Date: 2016-08
• Subjects: Clostridium difficile infection -- Colitis -- Ribotype -- Proton-pump inhibitors -- Antibiotics; CDI Clostridium difficile infection -- CI confidence interval -- CLSI Clinical and Laboratory Standards Institute -- ESBL extended-spectrum beta-lactamase -- HR hazard ratio -- IDSA Infectious Diseases Society of America -- OR odds ratio -- PCR polymerase chain reaction -- PPI proton-pump inhibitor -- SHEA Society for Healthcare Epidemiology of America; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2016.05.010
• Languages: English
• ISSNs: 0163-4453

Abstract

Summary: Objectives: We aim to study the disease burden, risk factors and severity of Clostridium difficile infection (CDI) in Hong Kong. Methods: We conducted a prospective, case–control study in three acute-care hospitals in Hong Kong. Adult inpatients who developed CDI diarrhoea confirmed by PCR (n = 139) were compared with the non-CDI controls (n = 114). Ribotyping of isolates and antimicrobial susceptibility testing were performed. Results: The estimated crude annual incidence of CDI was 23–33/100, 000 population, and 133–207/100, 000 population among those aged ≥65 years. The mean age of CDI patients was 71.5. Nursing home care, recent hospitalization, antibiotics exposure (adjusted OR 3.0, 95% CI 1.3–7.1) and proton-pump inhibitors use (adjusted OR 2.2, 95% CI 1.2–3.9) were risk factors. Severe CDI occurred in 41.7%. Overall mortality was 16.5% (among severe CDI, 26.5%). The commonest ribotypes were 002 (22.8%), 014 (14.1%), 012 and 046 ; ribotype 027 was absent. Ribotype 002 was associated with fluoroquinolone resistance and higher mortality (47.6% vs . 12.7%; adjusted HR 2.8, 95% CI 1.1–7.0). Conclusions: Our findings show high morbidity and mortality of CDI in the older adults, and identify ribotype 002 as a possible virulent strain causing serious infections in this cohort. Highlights: Clostridium difficile infection (CDI) is a major disease burden in Asia. The ribotype 027 is uncommon among CDI patients in Hong Kong. The ribotype 002 is a virulent strain associated with high mortality.