Disease burden of Clostridium difficile infections in adults, Hong Kong, China, 2006–2014

Jeffery Ho; Rudin Z.W. Dai; Thomas N.Y. Kwong; Xiansong Wang; Lin Zhang; Margaret Ip; Raphael Chan; Peter 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. Wu; Sunny H. Wong

doi:10.3201/eid2310.170797

Disease burden of Clostridium difficile infections in adults, Hong Kong, China, 2006–2014

Jeffery Ho, Rudin Z.W. Dai, Thomas N.Y. Kwong, Xiansong Wang, Lin Zhang, Margaret Ip, Raphael Chan, Peter 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. Wu, Sunny H. Wong^*

^*Corresponding author for this work

Public Health England

Research output: Contribution to journal › Article › peer-review

22 Citations (Scopus)

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.

Original language	English
Pages (from-to)	1671-1679
Number of pages	9
Journal	Emerging Infectious Diseases
Volume	23
Issue number	10
DOIs	https://doi.org/10.3201/eid2310.170797
Publication status	Published - Oct 2017

Bibliographical note

Funding Information:
This study was conducted in accordance with the Declaration of Helsinki (2013 version) and approved by the Joint Clinical Research Ethics Committee of the Chinese University of Hong Kong and Hospital Authority New Territory East Cluster. All clinical data were anonymized by the CDARS, and all potential patient identifiers were removed upon return of database searches.

Funding Information:
This study was supported by the Food and Health Bureau Health and Medical Research Fund (grant no. 15140132, HK-13-03-02), the General Research Fund (grant no. 24103516), the Shenzhen Science and Technology Program (grant no. JCYJ20150630165236954), and Department of Science and Technology of Guangdong Province, Natural Science Foundation of Guangdong Province (grant no. 2015A030313886). S.H.W. is supported by the Croucher Foundation and the Li Ka Shing Institute of Health Sciences.

Publisher Copyright:
© 2017, Centers for Disease Control and Prevention (CDC). All rights reserved.

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10.3201/eid2310.170797

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Ho, J., Dai, R. Z. W., Kwong, T. N. Y., Wang, X., Zhang, L., Ip, M., Chan, R., Hawkey, P., Lam, K. L. Y., Wong, M. C. S., Tse, G., Chan, M. T. V., Chan, F. K. L., Yu, J., Ng, S. C., Lee, N., Wu, J. C. Y., Sung, J. J. Y., Wu, W. K. K., & Wong, S. H. (2017). Disease burden of Clostridium difficile infections in adults, Hong Kong, China, 2006–2014. Emerging Infectious Diseases, 23(10), 1671-1679. https://doi.org/10.3201/eid2310.170797

@article{4e062eb797644a4c8ba7413c089cac81,

title = "Disease burden of Clostridium difficile infections 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{\textquoteright}s population.",

author = "Jeffery Ho and Dai, {Rudin Z.W.} and Kwong, {Thomas N.Y.} and Xiansong Wang and Lin Zhang and Margaret Ip and Raphael Chan and Peter Hawkey and Lam, {Kelvin L.Y.} and Wong, {Martin C.S.} and Gary Tse and Chan, {Matthew T.V.} and Chan, {Francis K.L.} and Jun Yu and Ng, {Siew C.} and Nelson Lee and Wu, {Justin C.Y.} and Sung, {Joseph J.Y.} and Wu, {William K.K.} and Wong, {Sunny H.}",

note = "Funding Information: This study was conducted in accordance with the Declaration of Helsinki (2013 version) and approved by the Joint Clinical Research Ethics Committee of the Chinese University of Hong Kong and Hospital Authority New Territory East Cluster. All clinical data were anonymized by the CDARS, and all potential patient identifiers were removed upon return of database searches. Funding Information: This study was supported by the Food and Health Bureau Health and Medical Research Fund (grant no. 15140132, HK-13-03-02), the General Research Fund (grant no. 24103516), the Shenzhen Science and Technology Program (grant no. JCYJ20150630165236954), and Department of Science and Technology of Guangdong Province, Natural Science Foundation of Guangdong Province (grant no. 2015A030313886). S.H.W. is supported by the Croucher Foundation and the Li Ka Shing Institute of Health Sciences. Publisher Copyright: {\textcopyright} 2017, Centers for Disease Control and Prevention (CDC). All rights reserved.",

year = "2017",

month = oct,

doi = "10.3201/eid2310.170797",

language = "English",

volume = "23",

pages = "1671--1679",

journal = "Emerging Infectious Diseases",

issn = "1080-6040",

publisher = "Centers for Disease Control and Prevention",

number = "10",

}

Ho, J, Dai, RZW, Kwong, TNY, Wang, X, Zhang, L, Ip, M, Chan, R, Hawkey, P, Lam, KLY, Wong, MCS, Tse, G, Chan, MTV, Chan, FKL, Yu, J, Ng, SC, Lee, N, Wu, JCY, Sung, JJY, Wu, WKK & Wong, SH 2017, 'Disease burden of Clostridium difficile infections in adults, Hong Kong, China, 2006–2014', Emerging Infectious Diseases, vol. 23, no. 10, pp. 1671-1679. https://doi.org/10.3201/eid2310.170797

TY - JOUR

T1 - Disease burden of Clostridium difficile infections in adults, Hong Kong, China, 2006–2014

AU - Ho, Jeffery

AU - Dai, Rudin Z.W.

AU - Kwong, Thomas N.Y.

AU - Wang, Xiansong

AU - Zhang, Lin

AU - Ip, Margaret

AU - Chan, Raphael

AU - Hawkey, Peter

AU - Lam, Kelvin L.Y.

AU - Wong, Martin C.S.

AU - Tse, Gary

AU - Chan, Matthew T.V.

AU - Chan, Francis K.L.

AU - Yu, Jun

AU - Ng, Siew C.

AU - Lee, Nelson

AU - Wu, Justin C.Y.

AU - Sung, Joseph J.Y.

AU - Wu, William K.K.

AU - Wong, Sunny H.

N1 - Funding Information: This study was conducted in accordance with the Declaration of Helsinki (2013 version) and approved by the Joint Clinical Research Ethics Committee of the Chinese University of Hong Kong and Hospital Authority New Territory East Cluster. All clinical data were anonymized by the CDARS, and all potential patient identifiers were removed upon return of database searches. Funding Information: This study was supported by the Food and Health Bureau Health and Medical Research Fund (grant no. 15140132, HK-13-03-02), the General Research Fund (grant no. 24103516), the Shenzhen Science and Technology Program (grant no. JCYJ20150630165236954), and Department of Science and Technology of Guangdong Province, Natural Science Foundation of Guangdong Province (grant no. 2015A030313886). S.H.W. is supported by the Croucher Foundation and the Li Ka Shing Institute of Health Sciences. Publisher Copyright: © 2017, Centers for Disease Control and Prevention (CDC). All rights reserved.

PY - 2017/10

Y1 - 2017/10

N2 - 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.

AB - 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.

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JO - Emerging Infectious Diseases

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SN - 1080-6040

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ER -

Disease burden of Clostridium difficile infections in adults, Hong Kong, China, 2006–2014

Abstract

Bibliographical note

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