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.
Highlights
Clostridium difficile causes infection ranging from mild diarrhoea to pseudomembranous colitis (PMC), primarily in older age patients who have been exposed to antibiotics
It is likely that the variant toxin A-negative/ toxin B-positive (A-B+) ribotype 017 C. difficile strain originated in Asia
In the absence of ribotyping studies other than that of Huang et al, a recent report of MLST typing on 69 C. difficile strains mainly from Beijing provides some further insight on the molecular epidemiology of C. difficile infection (CDI) in China [41]
Summary
Clostridium difficile causes infection ranging from mild diarrhoea to pseudomembranous colitis (PMC), primarily in older age patients who have been exposed to antibiotics. In the absence of ribotyping studies other than that of Huang et al, a recent report of MLST typing on 69 C. difficile strains mainly from Beijing provides some further insight on the molecular epidemiology of CDI in China [41]. The most recent report found a prevalence of non-toxigenic C. difficile of 12.6% among 79 hospitalised patients, five of whom subsequently developed diarrhoea with positive culture and toxin assay. While ribotypes 027 and 078 have caused outbreaks in North America and Europe, they are reported only to have caused sporadic cases of CDI in Asia so far, in Singapore, Hong Kong, Korea, and Japan [16,34,40,46, 49,63,74]. Broader surveillance monitoring CA-CDI and C. difficile in animals will enhance our understanding of the epidemiology of CDI in the region
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