Since 2004, there has been a decreasing global trend in the incidence of Clostridioides difficile infection, or CDI, with Europe experiencing a particularly strong decrease, according to findings from a systematic review and meta-analysis published in the American Journal of Infection Control. However, North America and Western Asia have experienced increased trends of incidence, researchers reported.
“As far as we know, this is the first comprehensive systematic review and meta-analysis of published studies on the global incidence of C. difficile infection,” Jeffery Ho, PhD, a medical laboratory scientist in the department of microbiology at The Chinese University of Hong Kong, and colleagues wrote. “Our analysis revealed geographical disparities in the disease burden (cumulative incidence) and continent-specific temporal changes of incidence.
Ho and colleagues conducted an initial literature search of studies published through October 2018 and used them to estimate pooled incidences of C. difficile.
The estimated global incidence of CDI increased from 6.60 per 10,000 patient-days in 1997 to 13.8 per 10,000 patient-days in 2004, the researchers reported. They observed a significant downward trend thereafter, at –8.75% annually until 2015.
The incidences in most European countries decreased at a rate between 1.97% and 4.11% per year from 2005 to 2015, Ho and colleagues reported. France, however, experienced an increasing incidence (beta = 0.16; P < .001). From 1997 through 2015, the pooled cumulative incidence was highest in North America, at 11.25 infections per 10,000 patient-days, and the incidence stabilized across the continent over the same period, according to the study. In Asia, the incidence increased significantly from 2006 to 2014 (annualized percentage change = 14.4%; P < .001). The researchers reported the greatest increase in Western Asian countries, including Turkey and Israel (beta > 0.10; P < .004). According to Ho and colleagues, the increase of disease incidence in Western Asia and North America may be attributable to the widespread use of antibiotics in these countries.
“This meta-analysis should inform the allocation of resources for controlling C. difficile infection and future surveillance efforts in countries where epidemiologic information on C. difficile remains sparse,” the researchers wrote. – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.