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Containment of Clostridium difficile infection without reduction in antimicrobial use in Hong Kong

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Abstract

Clostridium difficile ribotype 002 with hypersporulating capacity has been increasingly identified in Hong Kong. Proactive infection control measures are important to prevent the establishment of endemicity of C. difficile ribotype 002. A total of 329 patients with healthcare-associated C. difficile infection (CDI) were recruited in our healthcare network between 1 January 2008 and 30 June 2012 in this study. The incidence rates of healthcare-associated CDI per 10,000 admissions and 10,000 patient-days increased significantly by 15.3 and 17.0 %, respectively, per quarter (p < 0.001) from 2008 1Q to 2010 1Q by segmented Poisson regression. With the full implementation of enhanced infection control interventions, there was an immediate significant reduction in both healthcare-associated CDI rates per 10,000 admissions and per 10,000 patient-days by 47 % (p < 0.001) in 2010 2Q, followed by a further decline of CDI per 10,000 admissions and CDI per 10,000 patient-days by −19.4 and −19.8 % from 2010 2Q to 2012 2Q, respectively (p < 0.001), despite a replacement of hand washing with soap and water by alcohol-based hand rub in the healthcare network. The proportion of C. difficile ribotype 002 was not statistically different (34/177, 19.2 % vs. 25/152, 16.4 %, p = 0.515), and the consumption of broad-spectrum antibiotics presented as divided daily dose per 1,000 acute bed-day occupancy per quarter remained unchanged (140.9 vs. 152.3) before and after infection control interventions. Our results suggested that the reduction of healthcare-associated CDI was attributable to infection control interventions instead of replacement of ribotypes or reduction in antimicrobial selective pressure.

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Acknowledgments

This study was partially supported by the Health and Medical Research Fund (HMRF), Food and Health Bureau of the Hong Kong Special Administrative Region Government (ref. no. HKM-15-M12) and the commissioned block grant (project number: 260870158) of the Research Fund for the Control of Infectious Diseases of the Food and Health Bureau of the Hong Kong Special Administrative Region Government.

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China

    V. C. C. Cheng, S. Y. C. So, J. H. K. Chen, R. W. S. Poon, S. C. Y. Wong, P. L. Ho, W. C. Yam & K. Y. Yuen

  2. Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China

    V. C. C. Cheng, W. M. Lee & J. W. M. Tai

  3. School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, China

    P. H. Chau

  4. Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China

    I. F. N. Hung

Authors
  1. V. C. C. Cheng
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  2. P. H. Chau
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  3. S. Y. C. So
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  4. J. H. K. Chen
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  5. R. W. S. Poon
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  6. S. C. Y. Wong
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  7. I. F. N. Hung
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  8. W. M. Lee
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  9. J. W. M. Tai
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  10. P. L. Ho
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  11. W. C. Yam
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  12. K. Y. Yuen
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Corresponding author

Correspondence to K. Y. Yuen.

Additional information

Vincent CC Cheng hold a qualification of MBBS (HK), MD (HK), MRCP (UK), PDipID (HK), FRCPath, FHKCPath, and FHKAM (Pathology).

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Cheng, V.C.C., Chau, P.H., So, S.Y.C. et al. Containment of Clostridium difficile infection without reduction in antimicrobial use in Hong Kong. Eur J Clin Microbiol Infect Dis 34, 1381–1386 (2015). https://doi.org/10.1007/s10096-015-2362-5

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  • DOI: https://doi.org/10.1007/s10096-015-2362-5

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