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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 4

Cox proportional hazard regression analysis of potential independent variables associated with time to recurrence of Clostridium difficile infections, Hong Kong, China, 2006–2014*

Variable Univariate analysis
 Multivariate analysis
β Hazard ratio (95% CI) p value β Adjusted hazard ratio (95% CI) p value
Age, y
<44 NA 1.0 NA NA 1.0 NA
45−64 0.14 1.15 (0.86–1.55) 0.34 0.01 1.00 (0.74–1.36) 0.99
65−84 0.29 1.33 (0.01–1.75) 0.04 0.04 1.04 (0.78–1.38) 0.81
>85 0.41 1.50 (1.14–1.98) <0.01 0.16 1.17 (0.87–1.56) 0.29
Male sex −0.02 0.99 (0.88–1.10) 0.79 NA NA NA
Resident of home for elderly persons −0.02 0.98 (0.87–1.11) 0.99 NA NA NA
Severe disease† 0.32 1.38 (1.22–1.55) <0.01 0.35 1.41 (1.26–1.59) <0.01
Antimicrobial drug use‡
High-risk drug 0.49 1.55 (1.36–1.77) <0.01 0.32 1.37 (1.20–1.57) <0.01
Medium-risk drug 0.41 1.51 (1.33–1.72) 0.01 −0.01 0.99 (0.86–1.16) 0.96
Low-risk drug 0.11 1.12 (0.69–1.83) 0.66 NA NA NA
Diagnostic test
Bacterial culture NA 1.0 NA NA 1.0 NA
Toxin detection 0.69 1.89 (1.62–2.21) 0.01 0.57 1.79 (1.53–2.11) <0.01
NAAT 0.27 1.31 (1.12–1.52) 0.01 0.23 1.26 (1.08–1.47) <0.01
Use of proton-pump inhibitor 0.08 1.09 (0.97–1.22) 0.16 NA NA NA
Use of histamine-2 receptor antagonist 0.18 1.19 (1.07–1.34) 0.01 0.09 1.09 (0.97–1.22) 0.15
Healthcare-associated disease 0.49 1.65 (1.15–2.35) 0.01 0.42 1.52 (1.06–2.20) 0.02
Concurrent condition
Myocardial infarction 0.09 1.10 (0.92–1.32) 0.32 NA NA NA
Cerebrovascular disease 0.49 1.63 (1.46–1.82) <0.01 −0.15 0.86 (0.74–0.99) 0.04
Chronic lung disease −0.05 0.95 (0.82–1.12) 0.56 NA NA NA
Diabetes mellitus 0.08 1.08 (0.94–1.24) 0.30 NA NA NA
Renal disease 0.05 1.05 (0.92–1.20) 0.47 NA NA NA
Nonmetastatic tumor −0.24 0.79 (0.69–0.90) 0.01 −0.15 0.86 (0.74–0.99) 0.04
AIDS −0.58 0.56 (0.18–1.74) 0.32 NA NA NA
Inflammatory bowel disease 0.14 1.15 (0.62–2.14) 0.66 NA NA NA

*NA, not applicable; NAAT, nucleic acid amplification test.
†Severe disease was diagnosed according to the according to criteria of Cohen et al (13).
‡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).

Main Article

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1These authors contributed equally to this article.

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