Epidemiology of Clostridium difficile infection in Asia

Abstract

While Clostridium difficile infection (CDI) has come to prominence as major epidemics have occurred in North America and Europe over the recent decade, awareness and surveillance of CDI in Asia have remained poor. Limited studies performed throughout Asia indicate that CDI is also a significant nosocomial pathogen in this region, but the true prevalence of CDI remains unknown. A lack of regulated antibiotic use in many Asian countries suggests that the prevalence of CDI may be comparatively high. Molecular studies indicate that ribotypes 027 and 078, which have caused significant outbreaks in other regions of the world, are rare in Asia. However, variant toxin A-negative/toxin B-positive strains of ribotype 017 have caused epidemics across several Asian countries. Ribotype smz/018 has caused widespread disease across Japan over the last decade and more recently emerged in Korea. This review summarises current knowledge on CDI in Asian countries.

Figure 1

Ribotype distributions for studies in China (A,B), Hong Kong (C), Japan (D-G) and Korea (H-K). A: n = 75 isolates collected in 2008; 33 ribotypes identified [37]. B: n = 110, December 2008-May 2009; 16 ribotypes [39]. C: n = 345, 2009; 106 ribotypes [40]. D: n = 87, March 1996-November 1999; 12 ribotypes [8]. E: n = 148, November 1999-October 2004; 26 ribotypes [16]. F: n = 71, April 2005-March 2008; 20 ribotypes [14]. G: n = 87, 2003–2007; 18 ribotypes [17]. H: n = 187, 1980–2006; 39 ribotypes [27]. I: n = 105, 1995–2008; 11 ribotypes [32]. J: n = 337 toxigenic isolates, 2006–2008; 50 ribotypes [31]. K: n = 194, 2009–2010; 54 ribotypes [19].