Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 52 12 2023 11 28 2516 2527 Zahra Esfandiari Nutrition and Food Security Research Center, Department of Food Science and Technology, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Irana Parisa Shoaei Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Bahareh Vakili Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Ziba Farajzadegan Community and Preventive Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mohammad Javad Tarrahi Epidemiology Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran Zahra Emami Department of Food Science and Technology, College of Agriculture, Isfahan University of Technology, Isfahan, Iran Yadolah Fakhri Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran J. Scott Weese Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada Trias Mahmudiono Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia 2022 07 28 2023 05 29 Background: Meat and meat products are introduced as one of the carriers of Clostridioides difficile. This study aimed to determine the prevalence and antibiotic resistance of C. difficile isolates in meat and meat products using a systematic review and meta-analysis. Methods: It was performed a literature search in the primary international and bibliographic databases such as MEDLINE (PubMed), Cochrane Library, Embase, Scopus, and Web of Science to achieve all articles related to the prevalence and antibiotic resistance rates with no time restriction. A total of 54 studies examined C. difficile in 15,010 samples and its resistance to 10 antibiotics. Results: The pooled prevalence of C. difficile was 3.4% in all samples. C. difficile pooled prevalence was detected in fish, poultry, and red meat samples with 6.9%, 5.2%, and 3.2%, respectively. Regarding antibiotic resistance, the highest pooled prevalence was for ciprofloxacin (86.6%), followed by clindamycin (42.6%) and erythromycin (34%). The lowest pooled prevalence was observed in metronidazole (7.6%), vancomycin (6.6%), and chloramphenicol (6%). We found low resistance to commonly used drugs for C. difficile infection treatment. Conclusions: Every antibiotic can be a risk factor for CDI development, and drugs such as clindamycin, cephalosporins, and lately fluoroquinolones carry the highest risk. Therefore, we recommend the rational use of antibiotics in veterinary and human medicine https://ijph.tums.ac.ir/index.php/ijph/article/view/29426 https://ijph.tums.ac.ir/index.php/ijph/article/download/29426/8105