Clostridium difficile-associated Diarrhea in Developing Countries: A Systematic Review and Meta-Analysis

Daniel Curcio; Alejandro Cané; Francisco Andrés Fernández; Jorge Correa

doi:10.1007/s40121-019-0231-8

Clostridium difficile-associated Diarrhea in Developing Countries: A Systematic Review and Meta-Analysis

Infect Dis Ther. 2019 Mar;8(1):87-103. doi: 10.1007/s40121-019-0231-8. Epub 2019 Jan 18.

Authors

Daniel Curcio¹, Alejandro Cané², Francisco Andrés Fernández³, Jorge Correa⁴

Affiliations

¹ Vaccines Emerging Markets, Pfizer Inc, Buenos Aires, Argentina. Daniel.Curcio@pfizer.com.
² Vaccines Emerging Markets, Pfizer Inc, Buenos Aires, Argentina.
³ Content Medicine, Buenos Aires, Argentina.
⁴ Buenos Aires University, Buenos Aires, Argentina.

Abstract

Introduction: The prevalence of Clostridium difficile infection is rapidly increasing worldwide, but prevalence is difficult to estimate in developing countries where awareness, diagnostic resources, and surveillance protocols are limited. As diarrhea is the hallmark symptom, we conducted a systematic review and meta-analysis to determine the prevalence and incidence of C. difficile infection in patients in these regions who presented with diarrhea.

Methods: We conducted a systematic literature search of MEDLINE/PubMed, Scopus, and Latin-American and Caribbean Health Sciences Literature databases to identify and analyze data from recent studies providing prevalence or incidence rates of C. difficile-associated diarrhea in developing countries within four regions: Africa-Middle East, developing Asia, Latin America, and China. Our objectives were to determine the current prevalence and incidence density rates of first episodes of C. difficile-associated diarrhea in developing countries.

Results: Within the regions included in our analysis, prevalence of C. difficile infection in patients with diarrhea was 15% (95% CI 13-17%) (including community and hospitalized patients), with no significant difference across regions. The incidence of C. difficile infection in 17 studies including this information was 8.5 per 10,000 patient-days (95% CI 5.83-12.46). Prevalence was significantly higher in hospitalized patients versus community patients (p = 0.0227).

Conclusion: Our prevalence estimate of 15% is concerning; however, low awareness and inconsistent diagnostic and surveillance protocols suggest this is markedly underestimated. Enhanced awareness and management of C. difficile infection in patients with diarrhea, along with improvements in infection control and surveillance practices, should be implemented to reduce prevalence of C. difficile-associated diarrhea in developing countries.

Funding: Pfizer Inc.

Keywords: C. difficile-associated diarrhea; Clostridium difficile infection; Developing countries; Nosocomial diarrhea.