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.
Bibliographical noteFunding 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.
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.
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