TY - JOUR
T1 - Global burden of Clostridium difficile infections
T2 - A systematic review and meta-analysis
AU - Balsells, Evelyn
AU - Shi, Ting
AU - Leese, Callum
AU - Lyell, Iona
AU - Burrows, John
AU - Wiuff, Camilla
AU - Campbell, Harry
AU - Kyaw, Moe H.
AU - Nair, Harish
N1 - Funding Information:
We are thankful to University of Edinburgh, Medical Librarian, Ms. Marshall Dozier for her assistance in developing search strategies and to investigators who kindly provided data for meta-analyses. Editorial assistance with the preparation of the manuscript was provided by a professional medical writer, Nicola Truss PhD of inScience Communications, Springer Healthcare, UK. This work was supported financially by Sanofi Pasteur
Publisher Copyright:
© 2019 The Author(s) JoGH.
PY - 2019/6
Y1 - 2019/6
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85059503662&partnerID=8YFLogxK
U2 - 10.7189/jogh.09.010407
DO - 10.7189/jogh.09.010407
M3 - Article
C2 - 30603078
AN - SCOPUS:85059503662
SN - 2047-2978
VL - 9
JO - Journal of Global Health
JF - Journal of Global Health
IS - 1
M1 - 010407
ER -
