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

Evelyn Balsells (Lead / Corresponding author), Ting Shi, Callum Leese, Iona Lyell, John Burrows, Camilla Wiuff, Harry Campbell, Moe H. Kyaw, Harish Nair

Research output: Contribution to journalArticlepeer-review

118 Citations (Scopus)
3 Downloads (Pure)


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.

Original languageEnglish
Article number010407
Number of pages20
JournalJournal of Global Health
Issue number1
Early online date21 Dec 2018
Publication statusPublished - Jun 2019

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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