title: Containment of Clostridium difficile infection without reduction in antimicrobial use in Hong Kong.
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.
authors: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
authors: V C C
authors: VC
authors: Cheng
authors: P H
authors: PH
authors: Chau
authors: S Y C
authors: SY
authors: So
authors: J H K
authors: JH
authors: Chen
authors: R W S
authors: RW
authors: Poon
authors: S C Y
authors: SC
authors: Wong
authors: I F N
authors: IF
authors: Hung
authors: W M
authors: WM
authors: Lee
authors: J W M
authors: JW
authors: Tai
authors: P L
authors: PL
authors: Ho
authors: W C
authors: WC
authors: Yam
authors: K Y
authors: KY
authors: Yuen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics; D003015:Clostridium Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D003428:Cross Infection; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012621:Seasons
chemical_list: D000890:Anti-Infective Agents