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Volume 23, Number 10—October 2017

Research

Disease Burden of Clostridium difficile Infections in Adults, Hong Kong, China, 2006–2014

Jeffery Ho1, Rudin Z.W. Dai1, Thomas N.Y. Kwong, Xiansong Wang, Lin Zhang, Margaret Ip, Raphael Chan, Peter M.K. Hawkey, Kelvin L.Y. Lam, Martin C.S. Wong, Gary Tse, Matthew T.V. Chan, Francis K.L. Chan, Jun Yu, Siew C. Ng, Nelson Lee, Justin C.Y. Wu, Joseph J.Y. Sung, William K.K. WuComments to Author , and Sunny H. WongComments to Author 
Author affiliations: Chinese University of Hong Kong, Hong Kong, China (J. Ho, R.Z.W. Dai, T.N.Y. Kwong, X. Wang, L. Zhang, M. Ip, R. Chan, K.L.Y. Lam, M.C.S. Wong, G. Tse, M.T.V. Chan, F.K.L. Chan, J. Yu, S.C. Ng, N. Lee, J.C.Y. Wu, J.J.Y. Sung, W.K.K. Wu, S.H. Wong); Health Protection Agency, Birmingham, UK (P.M.K. Hawkey); University of Birmingham, Birmingham (P.M.K. Hawkey)

Main Article

Table 2

Characteristics of patients with Clostridium difficile infections, Hong Kong, China, 2006–2014*

Characteristic No. (%) patients
Overall, n = 15,753† HA-CDI, n = 14,402 CA-CDI, n = 817
Age, y
<44 1,040 (6.6) 893 (6.2) 105 (12.9)
45–64 2,930 (18.6) 2,621 (18.2) 203 (24.8)
65–84 7,026 (44.6) 6,495 (45.1) 301 (36.9)
>85 4,757 (30.2) 4,393 (30.5) 208 (25.4)
Sex
M 7,624 (48.4) 7,028 (48.8) 337 (41.2)
F 8,129 (51.6) 7,374 (51.2) 480 (58.8)
Resident of home for elderly persons 4,757 (30.2) 4,393 (30.5) 203 (24.9)
Severe disease 6,868 (43.6) 6,294 (43.7) 340 (41.6)
Antimicrobial drug use‡
High-risk drug 10,397 (66.0) 9,822 (68.2) 299 (36.6)
Medium-risk drug 11,909 (75.6) 11,320 (78.6) 318 (38.9)
Low-risk drug 221 (1.4) 216 (1.5) 74 (1.4)
Diagnostic test
Bacterial culture 4,883 (31.0) 4,421 (30.7) 259 (31.7)
Toxin detection 5,246 (33.3) 4,940 (34.3) 195 (23.9)
NAAT 5,624 (35.7) 5,041 (35.0) 363 (44.4)
Use of proton-pump inhibitor 7,530 (47.8) 7,086 (49.2) 180 (22.0)
Use of histamine-2 receptor antagonist 7,451 (47.3) 6,927 (48.1) 273 (33.4)
Concurrent condition
Myocardial infarction 1,497 (9.5) 1,411 (9.8) 29 (3.6)
Cerebrovascular disease 5,183 (32.9) 4,825 (33.5) 176 (21.6)
Chronic lung disease 2,410 (15.3) 2,232 (15.5) 100 (12.2)
Diabetes mellitus 2,899 (18.4) 2,693 (18.7) 103 (12.6)
Renal disease 3,592 (22.8) 3,341 (23.2) 113 (13.8)
Nonmetastatic tumor 3,970 (25.2) 3,701 (25.7) 134 (16.4)
AIDS 79 (0.5) 58 (0.4) 13 (1.6)
Inflammatory bowel disease 95 (0.6) 58 (0.4) 36 (4.4)
Deaths
During hospital stay 3,733 (23.7) 3,528 (24.5) 51 (6.2)
30-d all-cause 3,544 (22.5) 3,341 (23.2) 80 (9.8)
60-d all-cause 5,088 (32.3) 4,781 (33.2) 106 (13.0)
Recurrence, d§
30 961 (6.1) 907 (6.3) 17 (2.1)
60 1,229 (7.8) 1,152 (8.0) 25 (3.0)
90 1,339(8.5) 1,267 (8.8) 28 (3.4)
180 1,481(9.4) 1,397 (9.7) 33 (4.0)

*CA-CDI, community-associated C. difficile infection; CDI; HA-CDI, healthcare-associated C. difficile infection; NAAT, nucleic acid amplification test.
†Sum of HA-CDI and CA-CDI cases might not equal number of overall CDI cases because of missing information in the registry.
‡Antimicrobial drug use 8 weeks before diagnosis was stratified into high risk (floroquinolones, cephalosporins, and clindamycin); medium risk (penicillins, macrolides, and sulfonamides); and low risk (tetracyclines).
§Defined as reappearance of symptoms after initial resolution and a positive CDI test result.

Main Article

1These authors contributed equally to this article.

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