Sunny H Wong1, Margaret Ip2, Peter M Hawkey3, Norman Lo2, Katie Hardy4, Susan Manzoor4, Wyman W M Hui5, Kin-Wing Choi5, Rity Y K Wong6, Irene M H Yung6, Catherine S K Cheung6, Kelvin L Y Lam1, Thomas Kwong7, William K K Wu8, Siew C Ng1, Justin C Y Wu1, Joseph J Y Sung1, Nelson Lee9. 1. State Key Laboratory of Digestive Diseases, Institute of Digestive Diseases, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. 2. Department of Microbiology, The Chinese University of Hong Kong, Hong Kong. 3. Health Protection Agency, Public Health Laboratory Birmingham, Birmingham, United Kingdom; Institute of Microbiology, University of Birmingham, Birmingham, B15 2TT, United Kingdom. 4. Health Protection Agency, Public Health Laboratory Birmingham, Birmingham, United Kingdom. 5. Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong. 6. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. 7. State Key Laboratory of Digestive Diseases, Institute of Digestive Diseases, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong. 8. State Key Laboratory of Digestive Diseases, Institute of Digestive Diseases, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong; Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong. 9. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. Electronic address: leelsn@cuhk.edu.hk.
Abstract
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.
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.
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