Volume 27, Number 12—December 2021
CME ACTIVITY - Research
Trends in Incidence and Clinical Outcomes of Clostridioides difficile Infection, Hong Kong
Cosmos L.T. Guo1, Thomas N.Y. Kwong1, Joyce W.Y. Mak, Lin Zhang, Grace C.Y. Lui, Grace L.H. Wong, Margaret Ip, Jun Yu, Joseph J.Y. Sung, William K.K. Wu2, and Sunny H. Wong2
Table 2
Characteristics, outcomes, and procedures of patients with Clostridioides difficile infections, Hong Kong, China, 2015–2019*
| Characteristic | Overall | CA-CDI | HA-CDI | Indeterminate |
|---|---|---|---|---|
| All patients |
17,105 |
1,025 (6.0) |
15,717 (91.9) |
363 (2.1) |
| Age, y | ||||
| Median (IQR) | 77 (63–86) | 74 (58–85) | 77 (63–86) | 78 (62–86) |
| <44 | 1,056 (6.2) | 138 (13.5) | 901 (5.7) | 17 (4.7) |
| 45–64 | 3,679 (21.5) | 221 (21.6) | 3,375 (21.5) | 83 (22.9) |
| 65–74 | 3,027 (17.7) | 173 (16.9) | 2,793 (17.8) | 61 (16.8) |
| 75–84 | 4,340 (25.4) | 207 (20.2) | 4,044 (25.7) | 89 (24.5) |
| >85 |
5,003 (29.2) |
286 (27.9) |
4,604 (29.3) |
113 (31.1) |
| Sex | ||||
| M | 8,252 (48.2) | 442 (43.1) | 7,642 (48.6) | 168 (46.3) |
| F |
8,853 (51.8) |
583 (56.9) |
8,075 (51.4) |
195 (53.7) |
| Admission from OAH |
4,321 (25.3) |
209 (20.4) |
4,003 (25.5) |
109 (30.0) |
| IDSA-defined severe disease |
5,871 (35.8) |
295 (29.0) |
5,482 (36.5) |
94 (26.2) |
| Diagnostic test | ||||
| Bacterial culture | 8,191 (40.9) | 468 (39.4) | 7,560 (41.0) | 163 (38.6) |
| Nucleic acid amplification test | 8,994 (44.9) | 547 (46.0) | 8,261 (44.8) | 186 (44.1) |
| Toxin detection |
2,855 (14.2) |
173 (14.6) |
2,609 (14.2) |
73 (17.3) |
| Antimicrobial drug use | ||||
| High-risk drugs | 13,932 (81.4) | 272 (26.5) | 13,519 (86.0) | 141 (38.8) |
| Medium-risk drugs | 1,562 (9.1) | 23 (2.2) | 1,526 (9.7) | 13 (3.6) |
| Low-risk drugs | 4,286 (25.1) | 17 (1.7) | 4,257 (27.1) | 12 (3.3) |
| Broad-spectrum drugs |
10,147 (59.3) |
94 (9.2) |
9,986 (63.5) |
67 (18.5) |
| Use of other drugs | ||||
| Proton pump inhibitor | 10,614 (62.1) | 201 (19.6) | 10,255 (65.2) | 158 (43.5) |
| H2 antagonist | 4,950 (28.9) | 158 (15.4) | 4,722 (30.0) | 70 (19.3) |
| Corticosteroid |
4,477 (26.2) |
81 (7.9) |
4,350 (27.7) |
46 (12.7) |
| Underlying conditions | ||||
| Myocardial infarction | 1,212 (7.1) | 37 (3.6) | 1,144 (7.3) | 31 (8.5) |
| Congestive heart failure | 2,407 (14.1) | 64 (6.2) | 2,292 (14.6) | 51 (14.0) |
| Peripheral vascular disease | 556 (3.3) | 10 (1.0) | 536 (3.4) | 10 (2.8) |
| Cerebrovascular disease | 3,051 (17.8) | 91 (8.9) | 2,887 (18.4) | 73 (20.1) |
| Chronic pulmonary disease | 1,937 (11.3) | 84 (8.2) | 1,806 (11.5) | 47 (12.9) |
| Mild liver disease | 338 (2.0) | 18 (1.8) | 301 (1.9) | 19 (5.2) |
| Severe liver disease | 243 (1.4) | 11 (1.1) | 221 (1.4) | 11 (3.0) |
| Diabetes mellitus | 3,624 (21.2) | 131 (12.8) | 3,414 (21.7) | 79 (21.8) |
| Diabetes mellitus with complications | 1,492 (8.7) | 44 (4.3) | 1,406 (8.9) | 42 (11.6) |
| Moderate/severe kidney disease | 3,363 (19.7) | 94 (9.2) | 3,178 (20.2) | 91 (25.1) |
| Nonmetastatic cancer | 3,403 (19.9) | 75 (7.3) | 3,268 (20.8) | 60 (16.5) |
| Metastatic cancer | 970 (5.7) | 21 (2.0) | 932 (5.9) | 17 (4.7) |
| HIV | 16 (0.1) | 1 (0.1) | 15 (0.1) | 0 |
| Paraplegia | 356 (2.1) | 12 (1.2) | 336 (2.1) | 8 (2.2) |
| Connective tissue disease | 174 (1.0) | 15 (1.5) | 152 (1.0) | 7 (1.9) |
| Dementia | 863 (5.0) | 47 (4.6) | 793 (5.0) | 23 (6.3) |
| Peptic ulcer |
867 (5.1) |
24 (2.3) |
826 (5.3) |
17 (4.7) |
| Outcomes | ||||
| Episode death | 3,220 (18.8) | 73 (7.1) | 3,117 (19.8) | 30 (8.3) |
| 30-day mortality | 3,225 (18.9) | 87 (8.5) | 3,100 (19.7) | 38 (10.5) |
| 60-day mortality | 4,738 (27.7) | 117 (11.4) | 4,562 (29.0) | 59 (16.3) |
| 30-day recurrence | 1,968 (11.5) | 0 | 1,947 (12.4) | 21 (5.8) |
| Refractory disease |
2,155 (12.6) |
59 (5.8) |
2,064 (13.1) |
32 (8.8) |
| Procedures | ||||
| Partial colectomy | 3 (0.0) | 1 (0.1) | 2 (0.0) | 0 |
| Left colectomy | 3 (0.0) | 0 | 3 (0.0) | 0 |
| Right colectomy | 6 (0.0) | 0 | 6 (0.0) | 0 |
| Sigmoid colectomy | 1 (0.0) | 0 | 1 (0.0) | 0 |
| Total colectomy | 4 (0.0) | 1 (0.1) | 3 (0.0) | 0 |
| Fecal microbiota transplant | 3 (0.0) | 0 | 3 (0.0) | 0 |
*Values are no. (%) patients except as indicated. CA-CDI, community-associated Clostridioides difficile infection; HA-CDI, healthcare-associated Clostridioides difficile infection; IDSA, Infectious Diseases Society of America; IQR, interquartile range; OAH, old age home.
1These authors contributed equally to this work.
2These authors were co–principal investigators.
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