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Meta-Analysis
. 2019 Jun;9(1):010407.
doi: 10.7189/jogh.09.010407.

Global burden of Clostridium difficile infections: a systematic review and meta-analysis

Evelyn Balsells  1   2 , Ting Shi  1   2 , Callum Leese  1 , Iona Lyell  1 , John Burrows  1 , Camilla Wiuff  3 , Harry Campbell  1 , Moe H Kyaw  4   5 , Harish Nair  1   5
Affiliations
Meta-Analysis

Global burden of Clostridium difficile infections: a systematic review and meta-analysis

Evelyn Balsells et al. J Glob Health. 2019 Jun.

Abstract

Background: Clostridium difficile is a leading cause of morbidity and mortality in several countries. However, there are limited evidence characterizing its role as a global public health problem. We conducted a systematic review to provide a comprehensive overview of C. difficile infections (CDI) rates.

Methods: Seven databases were searched (January 2016) to identify studies and surveillance reports published between 2005 and 2015 reporting CDI incidence rates. CDI incidence rates for health care facility-associated (HCF), hospital onset-health care facility-associated, medical or general intensive care unit (ICU), internal medicine (IM), long-term care facility (LTCF), and community-associated (CA) were extracted and standardized. Meta-analysis was conducted using a random effects model.

Results: 229 publications, with data from 41 countries, were included. The overall rate of HCF-CDI was 2.24 (95% confidence interval CI = 1.66-3.03) per 1000 admissions/y and 3.54 (95%CI = 3.19-3.92) per 10 000 patient-days/y. Estimated rates for CDI with onset in ICU or IM wards were 11.08 (95%CI = 7.19-17.08) and 10.80 (95%CI = 3.15-37.06) per 1000 admission/y, respectively. Rates for CA-CDI were lower: 0.55 (95%CI = 0.13-2.37) per 1000 admissions/y. CDI rates were generally higher in North America and among the elderly but similar rates were identified in other regions and age groups.

Conclusions: Our review highlights the widespread burden of disease of C. difficile, evidence gaps, and the need for sustainable surveillance of CDI in the health care setting and the community.

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Conflict of interest statement

Competing interests: MHK is an employee of Sanofi Pasteur. EB, TS, CL, IL, JB, CW have no relevant conflict of interest to declare. HC and HN received grants from Sanofi Pasteur. HC is the Editor-in-Chief of the Journal of Global Health. All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no other conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Distribution of CDI incidence rates by category and age groupI a) number of CDI cases per 1000 admissions per year, b) incidence density per 10 000 patient-days, c) cumulative incidence per 100 000 population per year. Abbreviations: CDI, Clostridium difficile infection; HO-HCF, hospital-onset health care facility-associated; ICU, intensive care unit; IM, internal medicine; HCF, health care facility-associated; CA, community-associated; ICD, international classification of diseases; LTCF, long term care facility.
See this image and copyright information in PMC

References

    1. Lessa FC, Gould CV, McDonald LC. Current status of Clostridium difficile infection epidemiology. (Special Issue: Fidaxomicin and the evolving approach to the treatment of Clostridium difficile infection.). Clin Infect Dis. 2012;55:S65–70. doi: 10.1093/cid/cis319. - DOI - PMC - PubMed
    1. Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372:825–34. doi: 10.1056/NEJMoa1408913. - DOI - PMC - PubMed
    1. Barbut F, Mastrantonio P, Delmee M, Brazier J, Kuijper E, Poxton I, et al. Prospective study of Clostridium difficile infections in Europe with phenotypic and genotypic characterisation of the isolates. Clin Microbiol Infect. 2007;13:1048–57. doi: 10.1111/j.1469-0691.2007.01824.x. - DOI - PubMed
    1. Bauer MP, Notermans DW, van Benthem BH, Brazier JS, Wilcox MH, Rupnik M, et al. Clostridium difficile infection in Europe: a hospital-based survey. Lancet. 2011;377:63–73. doi: 10.1016/S0140-6736(10)61266-4. - DOI - PubMed
    1. Davies KA, Longshaw CM, Davis GL, Bouza E, Barbut F, Barna Z, et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis. 2014;14:1208–19. doi: 10.1016/S1473-3099(14)70991-0. - DOI - PubMed

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