Disease Burden ofClostridium difficileInfections in Adults, Hong Kong, China, 2006–2014

Abstract

Cross-sectional studies suggest an increasing trend in incidence and relatively low recurrence rates of Clostridium difficile infections in Asia than in Europe and North America. The temporal trend of C. difficile infection in Asia is not completely understood. We conducted a territory-wide population-based observational study to investigate the burden and clinical outcomes in Hong Kong, China, over a 9-year period. A total of 15,753 cases were identified, including 14,402 (91.4%) healthcare-associated cases and 817 (5.1%) community-associated cases. After adjustment for diagnostic test, we found that incidence increased from 15.41 cases/100,000 persons in 2006 to 36.31 cases/100,000 persons in 2014, an annual increase of 26%. This increase was associated with elderly patients, for whom incidence increased 3-fold over the period. Recurrence at 60 days increased from 5.7% in 2006 to 9.1% in 2014 (p<0.001). Our data suggest the need for further surveillance, especially in Asia, which contains ≈60% of the world’s population.

Clostridium difficile in Asia: Opportunities for One Health Management

“…Where reports do appear, they are frequently associated with infection with A-B+ strains [36,40]. Recurrence rates are also lower at 9%–13% [31,44,45,46] than those reported from North America (15%–20%) [6] and Europe (16%–22%) [19,47], however definitions of recurrence can vary from 8 weeks to 90 days for reappearance of symptoms after resolution of disease. The apparent rarity of severe outcomes of CDI in the region, such as PMC or toxic megacolon, is likely influenced by the poor awareness of CDI among physicians.…”

Cost‐effectiveness analysis of fecal microbiota transplantation for recurrent Clostridium difficile infection in patients with inflammatory bowel disease

“…CDI is often complicated with high recurrent rate resulting in prolonged hospitalization and high health‐care cost and is classified as an urgent threat to public health by the Centers for Disease Control and Prevention . In Hong Kong, CDI has become an emerging health‐care issue that the incidence of CDI increased from 15 cases to 36 cases per 100 000 persons between 2006 and 2014 …”

“…Patients with inflammatory bowel disease (IBD) belong to a high‐risk group for CDI . The incidence of concomitant IBD among patients with CDI ranged 4% to 16% . The risk of first recurrence of CDI in IBD patients (40%) is remarkably higher than the recurrence risk in non‐IBD patients (20–25%) .…”

Colonization of Toxigenic Clostridium difficile Among Intensive Care Unit Patients: A Multi-Centre Cross-Sectional Study

“…The clinical features vary from no symptoms (asymptomatic), infectious diarrhea, pseudomembranous colitis, toxic megacolon to even death (Ghose, 2013;Steele et al, 2015;Shoaei et al, 2019). Global attention has recently been directed toward the incidence of CD infection (CDI); despite efforts to prevent patient deterioration, CDI results in a worrisome outcome, and it is associated with increased morbidity, mortality, medical costs, and family burdens (Lin et al, 2015;Deshpande et al, 2017;Ho et al, 2017;Peng et al, 2018). In the United States, CDI prolongs hospital stays by 2.8-5.5 days, increases medical costs by $3,006-$15,397 per episode, and results in mortality in 5-10% of cases (Dubberke et al, 2016).…”