High morbidity and mortality of Clostridium difficile infection and its associations with ribotype 002 in Hong Kong

Sunny H. Wong; Margaret Ip; Peter Hawkey; Norman Lo; Katie Hardy; Susan Manzoor; Wyman W.M. Hui; Kin wing Choi; Rity Y.K. Wong; Irene M.H. Yung; Catherine S.K. Cheung; Kelvin L.Y. Lam; Thomas Kwong; William K.K. Wu; Siew C. Ng; Justin C.Y. Wu; Joseph J.Y. Sung; Nelson Lee

doi:10.1016/j.jinf.2016.05.010

High morbidity and mortality of Clostridium difficile infection and its associations with ribotype 002 in Hong Kong

Sunny H. Wong, Margaret Ip, Peter Hawkey, Norman Lo, Katie Hardy, Susan Manzoor, Wyman W.M. Hui, Kin wing Choi, Rity Y.K. Wong, Irene M.H. Yung, Catherine S.K. Cheung, Kelvin L.Y. Lam, Thomas Kwong, William K.K. Wu, Siew C. Ng, Justin C.Y. Wu, Joseph J.Y. Sung, Nelson Lee^*

^*Corresponding author for this work

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

25 Citations (Scopus)

Abstract

Objectives We aim to study the disease burden, risk factors and severity of Clostridium difficile infection (CDI) in Hong Kong. Methods We conducted a prospective, case–control study in three acute-care hospitals in Hong Kong. Adult inpatients who developed CDI diarrhoea confirmed by PCR (n = 139) were compared with the non-CDI controls (n = 114). Ribotyping of isolates and antimicrobial susceptibility testing were performed. Results The estimated crude annual incidence of CDI was 23–33/100,000 population, and 133–207/100,000 population among those aged ≥65 years. The mean age of CDI patients was 71.5. Nursing home care, recent hospitalization, antibiotics exposure (adjusted OR 3.0, 95% CI 1.3–7.1) and proton-pump inhibitors use (adjusted OR 2.2, 95% CI 1.2–3.9) were risk factors. Severe CDI occurred in 41.7%. Overall mortality was 16.5% (among severe CDI, 26.5%). The commonest ribotypes were 002 (22.8%), 014 (14.1%), 012 and 046; ribotype 027 was absent. Ribotype 002 was associated with fluoroquinolone resistance and higher mortality (47.6% vs. 12.7%; adjusted HR 2.8, 95% CI 1.1–7.0). Conclusions Our findings show high morbidity and mortality of CDI in the older adults, and identify ribotype 002 as a possible virulent strain causing serious infections in this cohort.

Original language	English
Pages (from-to)	115-122
Number of pages	8
Journal	Journal of Infection
Volume	73
Issue number	2
DOIs	https://doi.org/10.1016/j.jinf.2016.05.010
Publication status	Published - 1 Aug 2016

Bibliographical note

Funding Information:
This project is jointly supported by the Research Fund for the Control of Infectious Diseases ( CU-09-03-04 ), Food and Health Bureau of the Hong Kong Special Administrative Region Government ; and Departmental Research Fund , Faculty of Medicine, The Chinese University of Hong Kong. Dr Sunny H. Wong is supported by the Croucher Foundation .

Publisher Copyright:
© 2016 The British Infection Association

Keywords

Antibiotics
Clostridium difficile infection
Colitis
Proton-pump inhibitors
Ribotype

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jinf.2016.05.010

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Wong, S. H., Ip, M., Hawkey, P., Lo, N., Hardy, K., Manzoor, S., Hui, W. W. M., Choi, K. W., Wong, R. Y. K., Yung, I. M. H., Cheung, C. S. K., Lam, K. L. Y., Kwong, T., Wu, W. K. K., Ng, S. C., Wu, J. C. Y., Sung, J. J. Y., & Lee, N. (2016). High morbidity and mortality of Clostridium difficile infection and its associations with ribotype 002 in Hong Kong. Journal of Infection, 73(2), 115-122. https://doi.org/10.1016/j.jinf.2016.05.010

@article{604f63086e3b432491efbf73bff8c927,

title = "High morbidity and mortality of Clostridium difficile infection and its associations with ribotype 002 in Hong Kong",

abstract = "Objectives We aim to study the disease burden, risk factors and severity of Clostridium difficile infection (CDI) in Hong Kong. Methods We conducted a prospective, case–control study in three acute-care hospitals in Hong Kong. Adult inpatients who developed CDI diarrhoea confirmed by PCR (n = 139) were compared with the non-CDI controls (n = 114). Ribotyping of isolates and antimicrobial susceptibility testing were performed. Results The estimated crude annual incidence of CDI was 23–33/100,000 population, and 133–207/100,000 population among those aged ≥65 years. The mean age of CDI patients was 71.5. Nursing home care, recent hospitalization, antibiotics exposure (adjusted OR 3.0, 95% CI 1.3–7.1) and proton-pump inhibitors use (adjusted OR 2.2, 95% CI 1.2–3.9) were risk factors. Severe CDI occurred in 41.7%. Overall mortality was 16.5% (among severe CDI, 26.5%). The commonest ribotypes were 002 (22.8%), 014 (14.1%), 012 and 046; ribotype 027 was absent. Ribotype 002 was associated with fluoroquinolone resistance and higher mortality (47.6% vs. 12.7%; adjusted HR 2.8, 95% CI 1.1–7.0). Conclusions Our findings show high morbidity and mortality of CDI in the older adults, and identify ribotype 002 as a possible virulent strain causing serious infections in this cohort.",

keywords = "Antibiotics, Clostridium difficile infection, Colitis, Proton-pump inhibitors, Ribotype",

author = "Wong, {Sunny H.} and Margaret Ip and Peter Hawkey and Norman Lo and Katie Hardy and Susan Manzoor and Hui, {Wyman W.M.} and Choi, {Kin wing} and Wong, {Rity Y.K.} and Yung, {Irene M.H.} and Cheung, {Catherine S.K.} and Lam, {Kelvin L.Y.} and Thomas Kwong and Wu, {William K.K.} and Ng, {Siew C.} and Wu, {Justin C.Y.} and Sung, {Joseph J.Y.} and Nelson Lee",

note = "Funding Information: This project is jointly supported by the Research Fund for the Control of Infectious Diseases ( CU-09-03-04 ), Food and Health Bureau of the Hong Kong Special Administrative Region Government ; and Departmental Research Fund , Faculty of Medicine, The Chinese University of Hong Kong. Dr Sunny H. Wong is supported by the Croucher Foundation . Publisher Copyright: {\textcopyright} 2016 The British Infection Association",

year = "2016",

month = aug,

day = "1",

doi = "10.1016/j.jinf.2016.05.010",

language = "English",

volume = "73",

pages = "115--122",

journal = "Journal of Infection",

issn = "0163-4453",

publisher = "W.B. Saunders Ltd",

number = "2",

}

Wong, SH, Ip, M, Hawkey, P, Lo, N, Hardy, K, Manzoor, S, Hui, WWM, Choi, KW, Wong, RYK, Yung, IMH, Cheung, CSK, Lam, KLY, Kwong, T, Wu, WKK, Ng, SC, Wu, JCY, Sung, JJY & Lee, N 2016, 'High morbidity and mortality of Clostridium difficile infection and its associations with ribotype 002 in Hong Kong', Journal of Infection, vol. 73, no. 2, pp. 115-122. https://doi.org/10.1016/j.jinf.2016.05.010

TY - JOUR

T1 - High morbidity and mortality of Clostridium difficile infection and its associations with ribotype 002 in Hong Kong

AU - Wong, Sunny H.

AU - Ip, Margaret

AU - Hawkey, Peter

AU - Lo, Norman

AU - Hardy, Katie

AU - Manzoor, Susan

AU - Hui, Wyman W.M.

AU - Choi, Kin wing

AU - Wong, Rity Y.K.

AU - Yung, Irene M.H.

AU - Cheung, Catherine S.K.

AU - Lam, Kelvin L.Y.

AU - Kwong, Thomas

AU - Wu, William K.K.

AU - Ng, Siew C.

AU - Wu, Justin C.Y.

AU - Sung, Joseph J.Y.

AU - Lee, Nelson

N1 - Funding Information: This project is jointly supported by the Research Fund for the Control of Infectious Diseases ( CU-09-03-04 ), Food and Health Bureau of the Hong Kong Special Administrative Region Government ; and Departmental Research Fund , Faculty of Medicine, The Chinese University of Hong Kong. Dr Sunny H. Wong is supported by the Croucher Foundation . Publisher Copyright: © 2016 The British Infection Association

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Objectives We aim to study the disease burden, risk factors and severity of Clostridium difficile infection (CDI) in Hong Kong. Methods We conducted a prospective, case–control study in three acute-care hospitals in Hong Kong. Adult inpatients who developed CDI diarrhoea confirmed by PCR (n = 139) were compared with the non-CDI controls (n = 114). Ribotyping of isolates and antimicrobial susceptibility testing were performed. Results The estimated crude annual incidence of CDI was 23–33/100,000 population, and 133–207/100,000 population among those aged ≥65 years. The mean age of CDI patients was 71.5. Nursing home care, recent hospitalization, antibiotics exposure (adjusted OR 3.0, 95% CI 1.3–7.1) and proton-pump inhibitors use (adjusted OR 2.2, 95% CI 1.2–3.9) were risk factors. Severe CDI occurred in 41.7%. Overall mortality was 16.5% (among severe CDI, 26.5%). The commonest ribotypes were 002 (22.8%), 014 (14.1%), 012 and 046; ribotype 027 was absent. Ribotype 002 was associated with fluoroquinolone resistance and higher mortality (47.6% vs. 12.7%; adjusted HR 2.8, 95% CI 1.1–7.0). Conclusions Our findings show high morbidity and mortality of CDI in the older adults, and identify ribotype 002 as a possible virulent strain causing serious infections in this cohort.

AB - Objectives We aim to study the disease burden, risk factors and severity of Clostridium difficile infection (CDI) in Hong Kong. Methods We conducted a prospective, case–control study in three acute-care hospitals in Hong Kong. Adult inpatients who developed CDI diarrhoea confirmed by PCR (n = 139) were compared with the non-CDI controls (n = 114). Ribotyping of isolates and antimicrobial susceptibility testing were performed. Results The estimated crude annual incidence of CDI was 23–33/100,000 population, and 133–207/100,000 population among those aged ≥65 years. The mean age of CDI patients was 71.5. Nursing home care, recent hospitalization, antibiotics exposure (adjusted OR 3.0, 95% CI 1.3–7.1) and proton-pump inhibitors use (adjusted OR 2.2, 95% CI 1.2–3.9) were risk factors. Severe CDI occurred in 41.7%. Overall mortality was 16.5% (among severe CDI, 26.5%). The commonest ribotypes were 002 (22.8%), 014 (14.1%), 012 and 046; ribotype 027 was absent. Ribotype 002 was associated with fluoroquinolone resistance and higher mortality (47.6% vs. 12.7%; adjusted HR 2.8, 95% CI 1.1–7.0). Conclusions Our findings show high morbidity and mortality of CDI in the older adults, and identify ribotype 002 as a possible virulent strain causing serious infections in this cohort.

KW - Antibiotics

KW - Clostridium difficile infection

KW - Colitis

KW - Proton-pump inhibitors

KW - Ribotype

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U2 - 10.1016/j.jinf.2016.05.010

DO - 10.1016/j.jinf.2016.05.010

M3 - Article

C2 - 27246801

AN - SCOPUS:84976483169

SN - 0163-4453

VL - 73

SP - 115

EP - 122

JO - Journal of Infection

JF - Journal of Infection

IS - 2

ER -

High morbidity and mortality of Clostridium difficile infection and its associations with ribotype 002 in Hong Kong

Abstract

Bibliographical note

Keywords

UN SDGs

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