Highlights
- •The global incidence of Clostridium difficile infection increased before 2004.
- •A downward trend was observed after 2004.
- •The incidences have stabilized in North America.
- •The incidences have increased significantly in Asia.
Background
Previous decades have witnessed a change in the epidemiology of Clostridium difficile infections. This study aimed to determine temporal trends in the incidence of C difficile infection across geographic regions.
Methods
An initial search of the relevant literature was conducted from date inception to
October 2018 without language restriction. We estimated the pooled incidences using
logit transformation, weighted by inverse variance. The Joinpoint Regression Analysis
Program was used to explore its temporal trend.
Results
Globally, the estimated incidence of C difficile infection increased from 6.60 per 10,000 patient-days in 1997 to 13.8 per 10,000
patient-days in 2004. Thereafter, a significant downward trend was observed, at –8.75%
annually until 2015. From 2005 to 2015, the incidences in most European countries
decreased at a rate between 1.97% and 4.11% per annum, except in France, where an
increasing incidence was observed (β = 0.16; P < .001). The incidences have stabilized in North America over the same period; however,
in Asia, the incidence increased significantly from 2006 to 2014 (annualized percentage
change = 14.4%; P < .001). The increase was greatest in Western Asian countries, including Turkey and
Israel (β > 0.10; P < .004).
Conclusions
This study revealed rapid changes in the incidence of C difficile infection. 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 infection remains sparse.
Key Words
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Article Info
Publication History
Published online: August 03, 2019
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
