Burden of Clostridium (Clostridioides) difficile Infection among Patients in Western Asia: A Systematic Review and Meta-Analysis
-
Yalda MALEKZADEGAN
,
Mehrdad HALAJI
,
Meysam HASANNEJAD-BIBALAN
,
Saba JALALIFAR
,
Javad FATHI
,
Hadi Sedigh EBRAHIM-SARAIE
Abstract
Background: Clostridium difficile is the most common causes of hospital-acquired diarrhea affecting particularly hospitalized patients globally. This organism has re-emerged in recent years with significant morbidity and mortality. The present study aimed to estimate the burden of C. difficile infection (CDI) and to acquire information on the overall rates of community- and hospital-acquired CDI in western Asia.
Methods: A systematic literature search was performed to identify articles published from the eight Persian Gulf countries in western Asia including Iran, Iraq, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates in the electronic databases within Jan of 2000 to Dec of 2017. Then, 20 publications which met our inclusion criteria were selected for data extraction and analysis by Comprehensive Meta-Analysis Software.
Results: Twenty studies reported the prevalence of toxigenic strains of C. difficile among patients from Persian Gulf countries, of these the pooled prevalence of CDI was 9% (95% CI: 6.5%-12.5%). Totally, 8 studies showed the prevalence of hospital-acquired CDI, from those studies the prevalence of CDI was estimated 8.4% (95% CI: 4.9%-14.1%). Moreover, 7 studies reported the prevalence of community-acquired CDI, from those studies the prevalence of CDI was estimated 1.8% (95% CI: 1.2%-2.9%).
Conclusion: The prevalence of CDI in western Asia is lower than southern and eastern region. Moreover, the lower prevalence of community-acquired CDI compared to hospital-acquired CDI, indicate that the source of infection in western Asia is more likely in the hospitals.
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12. Di X, Bai N, Zhang X, et al (2015). A meta-analysis of metronidazole and vancomycin for the treatment of Clostridium difficile infection, stratified by disease severity. Braz J Infect Dis, 19(4):339-49.
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14. Jamal WY, Rotimi VO (2016). Surveillance of Antibiotic Resistance among Hospital- and Community-Acquired Toxigenic Clostridium difficile Isolates over 5-Year Period in Kuwait. PLoS One, 11(8):e0161411.
15. Bialvaei AZ, Kouhsari E, Salehi-Abargouei A, et al (2017). Epidemiology of multidrug-resistant Acinetobacter baumannii strains in Iran: a systematic review and meta-analysis. J Chemother, 29(6):327-37.
16. Sadeghifard N, Salari MH, Ghassemi MR et al (2010). The incidence of nosocomial toxigenic clostridium difficile associated diarrhea in Tehran tertiary medical centers. Acta Med Iran, 48(5):320-5.
17. Nazemalhosseini-Mojarad E, Azimirad M, Razaghi M, et al (2011). Frequency of Clostridium difficile among patients with gastrointestinal complaints. Gastroenterol Hepatol Bed Bench, 4(4):210-3.
18. Nasri MR, Khorvash F, Zolfaghari MR, Mobasherizadeh S (2012). The relative frequency of clostridium difficile in fecal samples of hospitalized patients with diarrhea by elisa method. J Isfahan Med School, 29(167):2376-82.
19. Jalali M, Khorvash F, Warriner K, Weese JS (2012). Clostridium difficile infection in an Iranian hospital. BMC Res Notes, 5:159.
20. Goudarzi M, Goudarzi H, Alebouyeh M, et al (2013). Antimicrobial susceptibility of clostridium difficile clinical isolates in iran. Iran Red Crescent Med J, 15(8):704-11.
21. Farshad S, Azami M, Pouladfar G et al (2013). Prevalence and risk factors of Clostridium difficile-Associated diarrhea in Iranian hospitalized patients. Ann Trop Med Public Health 6(5):554-8.
22. Azizi O, Aslani MM, Azimi Rad M et al (2013). The frequency of toxigenic strains of Clostridium difficile in hospitalized patients with diarrhea in Tehran/Iran by PCR method, 2010. J Kerman Univ Med Sci, 20(2):129-37.
23. Alinejad F, Barati M, Satarzadeh Tabrisi M, Saberi M (2015). Hospital acquired diarrhea in a burn center of Tehran. Iran J Microbiol, 7(6):310-4.
24. Rezazadeh Zarandi E, Mansouri S, Nakhaee N et al (2017). Frequency of antibiotic associated diarrhea caused by Clostridium difficile among hospitalized patients in intensive care unit, Kerman, Iran. Gastroenterol Hepatol Bed Bench, 10(3):229-34.
25. Azimirad M, Krutova M, Nyc O, et al (2017). Molecular typing of Clostridium difficile isolates cultured from patient stool samples and gastroenterological medical devices in a single Iranian hospital. Anaerobe, 47:125-8.
26. Sandokji AM, Murshid KR, El-Badry AA et al (2009). Infectious nosocomial diarrhea in the surgical wards: Role of parasites and microbes imply stool analysis. J Taibah Univ Med Sci, 4(1):73-81.
27. Al-Tawfiq JA, Abed MS (2010). Clostridium difficile-associated disease among patients in Dhahran, Saudi Arabia. Travel Med Infect Dis, 8(6):373-6.
28. Al-Eidan FA (2013). Proton pump inhibitors and the increased risk of Clostridium difficile infections: A case-control study. Int J Pharma Bio Sci, 4(2):B735-41.
29. Senok AC, Aldosari KM, Alowaisheq RA, et al (2017). Detection of clostridium difficile antigen and toxin in stool specimens: Comparison of the C. difficile quik chek complete enzyme immunoassay and GeneXpert C. difficile polymerase chain reaction assay. Saudi J Gastroenterol, 23(4):259-62.
30. Jamal W, Rotimi VO, Brazier J, Duerden BI (2010). Analysis of prevalence, risk factors and molecular epidemiology of Clostridium difficile infection in Kuwait over a 3-year period. Anaerobe, 16(6):560-5.
31. Jamal W, Pauline EM, Rotimi VO (2014). Comparative performance of the GeneXpert C. difficile PCR assay and C. diff Quik Chek Complete kit assay for detection of Clostridium difficile antigen and toxins in symptomatic community-onset infections. Int J Infect Dis, 29:244-8.
32. Jamal W, Pauline E, Rotimi V (2015). A prospective study of community-associated Clostridium difficile infection in Kuwait: Epidemiology and ribotypes. Anaerobe, 35(Pt B):28-32.
33. Albert MJ, Rotimi VO, Iqbal J, Chehadeh W (2016). Evaluation of the xTAG Gastrointestinal Pathogen Panel Assay for the Detection of Enteric Pathogens in Kuwait. Med Princ Pract, 25(5):472-6.
34. Alrifai SB, Alsaadi A, Mahmood YA et al (2009). Prevalence and etiology of nosocomial diarrhoea in children < 5 years in Tikrit teaching hospital. East Mediterr Health J, 15(5):1111-8.
35. Al-Thani AA, Hamdi WS, Al-Ansari NA et al (2014). Polymerase chain reaction ribotyping of Clostridium difficile isolates in Qatar: a hospital-based study. BMC Infect Dis, 14:502.
36. Quesada-Gomez C, Lopez-Urena D, Acuna-Amador L, et al (2015). Emergence of an outbreak-associated Clostridium difficile variant with increased virulence. J Clin Microbiol, 53(4):1216-26.
37. Vaishnavi C, Singh M, Mahmood S, Kochhar R (2015). Prevalence and molecular types of Clostridium difficile isolates from faecal specimens of patients in a tertiary care centre. J Med Microbiol, 64(11):1297-304.
38. Tang C, Cui L, Xu Y, et al (2016). The incidence and drug resistance of Clostridium difficile infection in Mainland China: a systematic review and meta-analysis. Sci Rep, 6:37865.
39. Kwon SS, Gim JL, Kim MS, et al (2017). Clinical and molecular characteristics of community-acquired Clostridium difficile infections in comparison with those of hospital-acquired C. difficile. Anaerobe, 48:42-6.
40. Borren NZ, Ghadermarzi S, Hutfless S, Ananthakrishnan AN (2017). The emergence of Clostridium difficile infection in Asia: A systematic review and meta-analysis of incidence and impact. PLoS One, 12(5):e0176797.
41. Pires RN, Monteiro AA, Carneiro LC, et al (2014). Clostridium difficile infection in Brazil: a neglected problem? Am J Infect Control, 42(4):459-60.
42. Kilic A, Alam MJ, Tisdel NL, et al (2015). Multiplex Real-Time PCR Method for Simultaneous Identification and Toxigenic Type Characterization of Clostridium difficile From Stool Samples. Ann Lab Med, 35(3):306-13.
43. Bauer MP, Notermans DW, van Benthem BH, et al (2011). Clostridium difficile infection in Europe: a hospital-based survey. Lancet, 377(9759):63-73.
44. Zhang D, Chen J, Zhan H, et al (2016). Clostridium difficile-associated clinical burden from lack of diagnostic testing in a Chinese tertiary hospital. J Hosp Infect. S0195-6701(16)30435-2.
45. van Dorp SM, Kinross P, Gastmeier P, et al (2016). Standardised surveillance of Clostridium difficile infection in European acute care hospitals: a pilot study, 2013. Euro Surveill, 21(29): doi: 10.2807/1560-7917.ES.2016.21.29.30293.
2. Sarani H, Balouchi A, Masinaeinezhad N, Ebrahimitabas E (2015). Knowledge, Attitude and Practice of Nurses about Standard Precautions for Hospital-Acquired Infection in Teaching Hospitals Affiliated to Zabol University of Medical Sciences (2014). Glob J Health Sci, 8(3):193-8.
3. Dancer SJ (2014). Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev, 27(4):665-90.
4. Asadian M, Sadeghi J, Rastegar Lari A et al (2016). Antimicrobial resistance pattern and genetic correlation in Enterococcus faecium isolated from healthy volunteers. Microb Pathog, 92:54-9.
5. Heinlen L, Ballard JD (2010). Clostridium difficile infection. Am J Med Sci, 340(3):247-52.
6. Depestel DD, Aronoff DM (2013). Epidemiology of Clostridium difficile infection. J Pharm Pract, 26(5):464-75.
7. Bignardi GE (1998). Risk factors for Clostridium difficile infection. J Hosp Infect, 40(1):1-15.
8. Surawicz CM (2015). Clostridium difficile infection: risk factors, diagnosis and management. Curr Treat Options Gastroenterol, 13(1):121-9.
9. Sedigh Ebrahim-Saraie H, Heidari H, Amanati A, et al (2018). A multicenter-based study on epidemiology, antibiotic suscepti-bility and risk factors of toxigenic Clostridium difficile in hospitalized patients in southwestern Iran. Infez Med, 26(4):308-15.
10. Khan FY, Abu-Khattab M, Anand D, et al (2012). Epidemiological features of Clostridium difficile infection among inpatients at Hamad General Hospital in the state of Qatar, 2006-2009. Travel Med Infect Dis, 10(4):179-85.
11. Nasiri MJ, Goudarzi M, Hajikhani B et al (2018). Clostridioides (Clostridium) difficile infection in hospitalized patients with antibiotic-associated diarrhea: A systematic review and meta-analysis. Anaerobe, 50:32-7.
12. Di X, Bai N, Zhang X, et al (2015). A meta-analysis of metronidazole and vancomycin for the treatment of Clostridium difficile infection, stratified by disease severity. Braz J Infect Dis, 19(4):339-49.
13. Di Bella S, Ascenzi P, Siarakas S et al (2016). Clostridium difficile Toxins A and B: Insights into Pathogenic Properties and Extraintestinal Effects. Toxins (Basel), 8(5):E134.
14. Jamal WY, Rotimi VO (2016). Surveillance of Antibiotic Resistance among Hospital- and Community-Acquired Toxigenic Clostridium difficile Isolates over 5-Year Period in Kuwait. PLoS One, 11(8):e0161411.
15. Bialvaei AZ, Kouhsari E, Salehi-Abargouei A, et al (2017). Epidemiology of multidrug-resistant Acinetobacter baumannii strains in Iran: a systematic review and meta-analysis. J Chemother, 29(6):327-37.
16. Sadeghifard N, Salari MH, Ghassemi MR et al (2010). The incidence of nosocomial toxigenic clostridium difficile associated diarrhea in Tehran tertiary medical centers. Acta Med Iran, 48(5):320-5.
17. Nazemalhosseini-Mojarad E, Azimirad M, Razaghi M, et al (2011). Frequency of Clostridium difficile among patients with gastrointestinal complaints. Gastroenterol Hepatol Bed Bench, 4(4):210-3.
18. Nasri MR, Khorvash F, Zolfaghari MR, Mobasherizadeh S (2012). The relative frequency of clostridium difficile in fecal samples of hospitalized patients with diarrhea by elisa method. J Isfahan Med School, 29(167):2376-82.
19. Jalali M, Khorvash F, Warriner K, Weese JS (2012). Clostridium difficile infection in an Iranian hospital. BMC Res Notes, 5:159.
20. Goudarzi M, Goudarzi H, Alebouyeh M, et al (2013). Antimicrobial susceptibility of clostridium difficile clinical isolates in iran. Iran Red Crescent Med J, 15(8):704-11.
21. Farshad S, Azami M, Pouladfar G et al (2013). Prevalence and risk factors of Clostridium difficile-Associated diarrhea in Iranian hospitalized patients. Ann Trop Med Public Health 6(5):554-8.
22. Azizi O, Aslani MM, Azimi Rad M et al (2013). The frequency of toxigenic strains of Clostridium difficile in hospitalized patients with diarrhea in Tehran/Iran by PCR method, 2010. J Kerman Univ Med Sci, 20(2):129-37.
23. Alinejad F, Barati M, Satarzadeh Tabrisi M, Saberi M (2015). Hospital acquired diarrhea in a burn center of Tehran. Iran J Microbiol, 7(6):310-4.
24. Rezazadeh Zarandi E, Mansouri S, Nakhaee N et al (2017). Frequency of antibiotic associated diarrhea caused by Clostridium difficile among hospitalized patients in intensive care unit, Kerman, Iran. Gastroenterol Hepatol Bed Bench, 10(3):229-34.
25. Azimirad M, Krutova M, Nyc O, et al (2017). Molecular typing of Clostridium difficile isolates cultured from patient stool samples and gastroenterological medical devices in a single Iranian hospital. Anaerobe, 47:125-8.
26. Sandokji AM, Murshid KR, El-Badry AA et al (2009). Infectious nosocomial diarrhea in the surgical wards: Role of parasites and microbes imply stool analysis. J Taibah Univ Med Sci, 4(1):73-81.
27. Al-Tawfiq JA, Abed MS (2010). Clostridium difficile-associated disease among patients in Dhahran, Saudi Arabia. Travel Med Infect Dis, 8(6):373-6.
28. Al-Eidan FA (2013). Proton pump inhibitors and the increased risk of Clostridium difficile infections: A case-control study. Int J Pharma Bio Sci, 4(2):B735-41.
29. Senok AC, Aldosari KM, Alowaisheq RA, et al (2017). Detection of clostridium difficile antigen and toxin in stool specimens: Comparison of the C. difficile quik chek complete enzyme immunoassay and GeneXpert C. difficile polymerase chain reaction assay. Saudi J Gastroenterol, 23(4):259-62.
30. Jamal W, Rotimi VO, Brazier J, Duerden BI (2010). Analysis of prevalence, risk factors and molecular epidemiology of Clostridium difficile infection in Kuwait over a 3-year period. Anaerobe, 16(6):560-5.
31. Jamal W, Pauline EM, Rotimi VO (2014). Comparative performance of the GeneXpert C. difficile PCR assay and C. diff Quik Chek Complete kit assay for detection of Clostridium difficile antigen and toxins in symptomatic community-onset infections. Int J Infect Dis, 29:244-8.
32. Jamal W, Pauline E, Rotimi V (2015). A prospective study of community-associated Clostridium difficile infection in Kuwait: Epidemiology and ribotypes. Anaerobe, 35(Pt B):28-32.
33. Albert MJ, Rotimi VO, Iqbal J, Chehadeh W (2016). Evaluation of the xTAG Gastrointestinal Pathogen Panel Assay for the Detection of Enteric Pathogens in Kuwait. Med Princ Pract, 25(5):472-6.
34. Alrifai SB, Alsaadi A, Mahmood YA et al (2009). Prevalence and etiology of nosocomial diarrhoea in children < 5 years in Tikrit teaching hospital. East Mediterr Health J, 15(5):1111-8.
35. Al-Thani AA, Hamdi WS, Al-Ansari NA et al (2014). Polymerase chain reaction ribotyping of Clostridium difficile isolates in Qatar: a hospital-based study. BMC Infect Dis, 14:502.
36. Quesada-Gomez C, Lopez-Urena D, Acuna-Amador L, et al (2015). Emergence of an outbreak-associated Clostridium difficile variant with increased virulence. J Clin Microbiol, 53(4):1216-26.
37. Vaishnavi C, Singh M, Mahmood S, Kochhar R (2015). Prevalence and molecular types of Clostridium difficile isolates from faecal specimens of patients in a tertiary care centre. J Med Microbiol, 64(11):1297-304.
38. Tang C, Cui L, Xu Y, et al (2016). The incidence and drug resistance of Clostridium difficile infection in Mainland China: a systematic review and meta-analysis. Sci Rep, 6:37865.
39. Kwon SS, Gim JL, Kim MS, et al (2017). Clinical and molecular characteristics of community-acquired Clostridium difficile infections in comparison with those of hospital-acquired C. difficile. Anaerobe, 48:42-6.
40. Borren NZ, Ghadermarzi S, Hutfless S, Ananthakrishnan AN (2017). The emergence of Clostridium difficile infection in Asia: A systematic review and meta-analysis of incidence and impact. PLoS One, 12(5):e0176797.
41. Pires RN, Monteiro AA, Carneiro LC, et al (2014). Clostridium difficile infection in Brazil: a neglected problem? Am J Infect Control, 42(4):459-60.
42. Kilic A, Alam MJ, Tisdel NL, et al (2015). Multiplex Real-Time PCR Method for Simultaneous Identification and Toxigenic Type Characterization of Clostridium difficile From Stool Samples. Ann Lab Med, 35(3):306-13.
43. Bauer MP, Notermans DW, van Benthem BH, et al (2011). Clostridium difficile infection in Europe: a hospital-based survey. Lancet, 377(9759):63-73.
44. Zhang D, Chen J, Zhan H, et al (2016). Clostridium difficile-associated clinical burden from lack of diagnostic testing in a Chinese tertiary hospital. J Hosp Infect. S0195-6701(16)30435-2.
45. van Dorp SM, Kinross P, Gastmeier P, et al (2016). Standardised surveillance of Clostridium difficile infection in European acute care hospitals: a pilot study, 2013. Euro Surveill, 21(29): doi: 10.2807/1560-7917.ES.2016.21.29.30293.
| Files | ||
| Issue | Vol 48 No 9 (2019) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v48i9.3015 | |
| Keywords | ||
| Clostridium difficile infection (CDI) Western Asia Infection control Meta-analysis | ||
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How to Cite
1.
MALEKZADEGAN Y, HALAJI M, HASANNEJAD-BIBALAN M, JALALIFAR S, FATHI J, EBRAHIM-SARAIE HS. Burden of Clostridium (Clostridioides) difficile Infection among Patients in Western Asia: A Systematic Review and Meta-Analysis. Iran J Public Health. 2019;48(9):1589-1599.
