Prevalence and antimicrobial resistance pattern of Clostridium difficile among hospitalized diarrheal patients: A systematic review and meta-analysis

Abstract

Background Clostridium difficile is the leading cause of infectious diarrhea that develops in patients after hospitalization during antibiotic administration. It has also become a big issue in community-acquired diarrhea. The emergence of hypervirulent strains of C. difficile poses a major problem in hospital-associated diarrhea outbreaks and it is difficult to treat. The antimicrobial resistance in C. difficile has worsened due to the inappropriate use of broad-spectrum antibiotics including cephalosporins, clindamycin, tetracycline, and fluoroquinolones together with the emergence of hypervirulent strains. Objective To estimate the pooled prevalence and antimicrobial resistance pattern of C. difficile derived from hospitalized diarrheal patients, a systematic review and meta-analysis was performed. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to review published studies conducted. We searched bibliographic databases from PubMed, Scopus, Google Scholar, and Cochrane Library for studies on the prevalence and antimicrobial susceptibility testing on C. difficile. The weighted pooled prevalence and resistance for each antimicrobial agent was calculated using a random-effects model. A funnel plot and Egger’s regression test were used to see publication bias. Results A total of 15 studies were included. Ten articles for prevalence study and 5 additional studies for antimicrobial susceptibility testing of C. difficile were included. A total of 1967/7852 (25%) C. difficile were isolated from 10 included studies for prevalence study. The overall weighted pooled proportion (WPP) of C. difficile was 30% (95% CI: 10.0–49.0; p<0.001). The analysis showed substantial heterogeneity among studies (Cochran’s test = 7038.73, I2 = 99.87%; p<0.001). The weighed pooled antimicrobial resistance (WPR) were: vancomycin 3%(95% CI: 1.0–4.0, p<0.001); metronidazole 5%(95% CI: 3.0–7.0, p<0.001); clindamycin 61%(95% CI: 52.0–69.0, p<0.001); moxifloxacin 42%(95% CI: 29–54, p<0.001); tetracycline 35%(95% CI: 22–49, p<0.001); erythromycin 61%(95% CI: 48–75, p<0.001) and ciprofloxacin 64%(95% CI: 48–80; p< 0.001) using the random effect model. Conclusions A higher weighted pooled prevalence of C. difficile was observed. It needs a great deal of attention to decrease the prevailing prevalence. The resistance of C. difficile to metronidazole and vancomycin was low compared to other drugs used to treat C. difficile infection. Periodic antimicrobial resistance monitoring is vital for appropriate therapy of C. difficile infection.

Atypical Splenic Abscesses Due to Clostridioides difficile

“…The antibiotics used to treat C. difficile splenic abscesses were intravenous vancomycin, metro-nidazole, and penicillin, although antimicrobial susceptibilities of C. difficile were not available except for our case ( Tables 1 , 2 ). The systematic review and meta-analysis on C. difficile infection among hospitalized diarrheal patients showed that the resistance to metronidazole and vancomycin was low compared to other drugs, including clindamycin [ 25 ]. A single-center retrospective study on ECDI demonstrated that all isolates (100%) were susceptible to metronidazole and piperacillin-tazobactam, while 63% and 9% of isolates were susceptible to ertapenem and clindamycin, respectively [ 14 ].…”

Peroxisome proliferator-activated receptor-γ as the gatekeeper of tight junction in Clostridioides difficile infection

“…Current antibiotic therapies, including treatments with vancomycin and fidaxomicin, may alleviate the disease (Khanna et al, 2016;Cho et al, 2020). However, the emergence of antibiotic-resistant C. difficile strains and the risk of recurrent CDI (rCDI) after antibiotic treatment are major public health concerns (Cornely et al, 2012;Sholeh et al, 2020;Tsigrelis, 2020;Dilnessa et al, 2022). Although fecal microbiota transplantation is effective in treating rCDI, the efficacy, safety, and stability of this method need to be considered and discussed (Weingarden et al, 2015;Colleen et al, 2016;Youngster et al, 2016;Chiu et al, 2021).…”

Prevalence, Antibiotic Resistance, and Genetic Diversities of Clostridium difficile in Meat Nuggets from Various Sources in Isfahan, Iran

“…Tis bacterium came into the limelight in 1978 as the leading cause of diarrhea caused by antibiotics, called "Antibiotic-Associated Diarrhea." Also, this disease was introduced as the prime cause of pseudomembranous colitis and patient mortalities, particularly in the elderly [6]. Toxin A (tcd A) and toxin B (tcdB) are two virulence factors associated with C. difcile infection, which are enterotoxin and cytotoxin, respectively [7].…”