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. 2025 Mar 27;7(2):otaf024.
doi: 10.1093/crocol/otaf024. eCollection 2025 Apr.

Global Patterns of Clostridioides difficile Infection in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis of Prevalence, Epidemiology, and Risk Factors

Dominic Amakye  1 , Paddy Ssentongo  2 , Swapnil Patel  3 , Shannon Dalessio  4 , Smriti Kochhar  3 , Arsh Momin  3 , Kofi Clarke  4
Affiliations

Global Patterns of Clostridioides difficile Infection in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis of Prevalence, Epidemiology, and Risk Factors

Dominic Amakye et al. Crohns Colitis 360. .

Abstract

Background: Clostridioides difficile infection (CDI) is a well-recognized complication of inflammatory bowel disease (IBD) that has been associated with poor clinical outcomes. The objective of this study is to characterize the global incidence, risk factors and outcomes of CDI in patients with IBD.

Methods: A search of MEDLINE/PubMed, Scopus, and Cochrane Database of Systematic Reviews was conducted for studies published between January 1960, and March 2024. Random-effect models were employed to estimate the incidence of CDI in the IBD population. Risk factors and outcomes were estimated using random effects meta-regression and subgroup analysis.

Results: Twenty-eight articles from 11 countries on 3 continents, comprising 796, 244 patients with IBD were included. The overall CDI rate was 8.84% (95% CI, 5.91%-13.03%). The rate of CDI was slightly higher in Asia at 11% (95% CI, 6.7%-18.44%) compared to the North America (USA and Canada) at 7.85% (95% CI, 3.80%-15.51%) and Europe, where the incidence, was 7.92% (95% CI, 3.87%-15.51%). A univariable random-effects meta-regression model demonstrated that male gender (odds ratio [OR], 1.18; 95% CI, 1.00-1.40) and older age (OR, 1.06; 95% CI, 0.99-1.15, per one-year increase in age) were factors associated with higher CDI incidence in the IBD population. CDI testing by PCR compared to enzyme immunoassay was associated with higher rates of CDI (OR, 4.70; 95% CI, 01.39-15.90). No association was observed between length of hospital stay and CDI.

Conclusions: One in 10 patients with IBD were positive for CDI. Increasing age and male population were associated with higher risk of CDI.

Keywords: Clostridioides difficile infection; epidemiology; inflammatory bowel disease; meta-analysis; risk factors.

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Conflict of interest statement

KC holds the position of Associate Editor for Crohn’s & Colitis 360 and has been recused from reviewing or making decisions about the manuscript.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
PRISMA flow diagram showing study selection.
Figure 2.
Figure 2.
Overall incidence of CDI in IBD flare.
Figure 3.
Figure 3.
CDI incidence by geographic location stratified by continents.
Figure 4.
Figure 4.
Association of age, gender, and study year with the observed incidence of CDI in IBD patients.
Figure 5.
Figure 5.
Influence and outlier sensitivity analyses. No study was an outlier or substantially influenced the pooled estimates.
Figure 6.
Figure 6.
Funnel plot demonstrating the distribution of effect estimates a function of sample size of the study.
Figure 7:
Figure 7:
Duval and Tweedie trim and fill analysis: 12 additional studies were added balance the funnel plots.
See this image and copyright information in PMC

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