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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 5

Temporal change in exposure prevalence for patients with Clostridium difficile infections in association with trend in recurrence, Hong Kong, China, 2006–2014*

Exposure Period, prevalence (standardized Pearson residuals), %
Absolute residual difference, %† p value‡
2006–2008 2009–2011 2012–2014
Age, y
<44 18.3 (0.4) 34.9 (3.0) 46.8 (−2.5) 2.9 <0.01
45–64 17.4 (−0.6) 32.5 (2.6) 50.1 (−1.7) 1.1 <0.01
65–84 19.2 (2.7) 28.9 (−1.4) 51.9 (−0.5) 3.2 <0.01
>85 16.1 (−3.0) 28.4 (−1.8) 55.5 (3.1) 6.1 <0.01
Male sex 48.6 (0.1) 48.5 (0.0) 48.4 (−0.1) 0.2 0.97
Resident of home for elderly persons 27.6 (−2.6) 29.5 (−1.0) 31.6 (2.3) 4.9 <0.01
Severe disease 16.9 (10.5) 32.6 (2.6) 50.5 (−6.7) 17.2 <0.01
Antimicrobial drug use§
High-risk drug 18.5 (1.5) 28.4 (−2.7) 53.1 (1.2) 0.3 0.65
Medium-risk drug 17.4 (−1.1) 28.1 (−3.6) 54.5 (3.3) 4.4 <0.01
Low-risk drug 12.6 (−1.9) 19.3 (−2.9) 152 (3.3) 5.2 <0.01
Diagnostic test
Bacterial culture 18.9 (1.7) 29.0 (−1.0) 52.0 (−0.3) 2 <0.01
Toxin detection 36.0 (31.1) 35.0 (6.9) 28.9 (−23.4) 54.5 <0.01
NAAT 0 (−31.7) 25.7 (−5.7) 74.3 (22.9) 54.6 <0.01
Use of proton-pump inhibitor 35.8 (−9.0) 40.7 (−6.6) 55.2 (10.3) 19.3 <0.01
Use of histamine-2 receptor antagonist 54.7 (6.0) 46.1 (−0.9) 44.9 (−2.9) 8.9 <0.01
Healthcare-associated disease 18.1 (0.7) 30.0 (0.5) 51.9 (−0.7) 1.4 <0.01
Concurrent condition
Myocardial infarction 5.3 (−7.2) 7.9 (−3.4) 11.7 (6.8) 14 <0.001
Cerebrovascular disease accident 28.8 (−3.4) 32.8 (0.5) 33.5 (1.7) 5.1 <0.01
Chronic lung disease 12.4 (−3.6) 14.5 (−1.0) 16.3 (2.9) 6.5 <0.01
Diabetes mellitus 20.5 (2.6) 19.0 (1.0) 17.3 (−2.3) 4.9 <0.01
Renal disease 18.4 (−4.8) 22.5 (−0.2) 24.3 (3.1) 7.9 <0.01
Nonmetastatic tumor 21.7 (−3.7) 27.1 (2.6) 25.2 (0.2) 3.9 0.01
AIDS 0.5 (0.2) 0.6 (0.8) 0.4 (−0.7) 0.9 0.55
Inflammatory bowel disease 0.5 (−2.0) 0.7 (−1.2) 1.1 (2.2) 4.4 0.01

*NAAT, nucleic acid amplification test.
†Absolute difference between standardized Pearson residuals in 2012–2014 and 2006–2008.
‡By χ2 test for trend.
§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

1These authors contributed equally to this article.

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