The incidence and drug resistance of Clostridium difficile infection in Mainland China: a systematic review and meta-analysis

Abstract

It has been widely reported that the incidence and severity of Clostridium difficile infection (CDI) have increased dramatically in North America and Europe. However, little is known about CDI in Mainland China. In this study, we aimed to investigate the incidence of CDI and the main epidemic and drug-resistant strains of C. difficile in Mainland China through meta-analysis of related studies published after the year 2010. A total of 51 eligible studies were included. The pooled incidence of toxigenic C. difficile among patients with diarrhoea was 14% (95% CI = 12–16%). In Mainland China, ST-37 and ST-3 were the most prevalent strains; fortunately, hypervirulent strains, such as ST-1 (BI/NAP1/027) and ST-11 (RT 078), have only occurred sporadically to date. The rates of C. difficile resistance to ciprofloxacin (98.3%; 95% CI = 96.9–99.7%), clindamycin (81.7%; 95% CI = 76.1–87.3%) and erythromycin (80.2%; 95% CI = 73.5–86.9%) are higher than in other counties; however, none of the C. difficile isolates reported in Mainland China were resistant to metronidazole (n/N = 0/960), vancomycin (n/N = 0/960), tigecycline (n/N = 0/41) or piperacillin/tazobactam(n/N = 0/288).

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China

“…To reveal the epidemiology of CDI in mainland China, in this non-outbreak situation, specific genotypes of toxigenic C. difficile strains were observed. ST2 was the most predominant genotype, while recent studies reported that ST54, ST3 and ST37 were the most prevalent genotypes in mainland China [6,33,[36][37][38]. Noteworthily, in addition to ST54 and ST3, ST35 also emerged both in this work and another inspection in Yunnan [39], a province bordering Chongqing, witnessing the spread of this toxin genotype over provinces in China.…”

“…Geographical heterogeneity and transcontinental dissemination have aroused more concerns about regional CDI surveillance. In China, although the state of dilemma introduced by CDI has been documented before [6,7], data are lacking in the central and western regions. To fill gaps in the epidemiological territory of CDI in China, the results in this study presented basic knowledge of the prevalence and mortality of HA-CDI, and helped to improve the recognition of patients at high risk for HA-CDI Fig.…”

“…Although many studies have explored the CDI situation in China, the lack of epidemiological data in blind areas impedes a full understanding of CDI in this country. To the best of our knowledge, this is the first study of HA-CDI in Chongqing, a provincial administrative unit in Southwest China [6]. Our study was initiated to investigate the impact of HA-CDI by identifying its prevalence, determine the risk factors for the acquisition of this dilemma in patients with antibiotic-associated diarrhea (AAD), reveal the mortality of HA-CDI in this teaching hospital and inquire into the molecular epidemiology and antimicrobial resistance of C.difficile isolates found in this study.…”

“…However, unlike the rest of East Asia, limited data have focused on the burden of CDI in China. Although few regional studies alarmed that the hyper-virulent C. difficile strain ST-1 (BI/NAP1/027), an epidemic strain in Europe and North America, has emerged in Chinese hospital settings, recent reports revealed that ST35, ST37 and ST3 were the most prevalent genotypes in mainland China [6,7]. Moreover, in consideration of the complex personnel mobility in medical institutions, the majority of CDI is hospital-acquired, and nosocomial transmission of C. difficile contributes greatly to the spread of different genotypes.…”

Novel drug delivery systems to combat antimicrobial resistance

“…Upon initiation of antibiotic therapy, the normal gut flora was disrupted, enabling C. difficile to persist in the gut as the dominant bacteria and induce colitis [66,67]. Keeping in mind that virulence if often tied to resistance [68], the emergence of highly virulent strains of this bacteria and a reduced susceptibility to antibiotics has led to the development of MDR strains [69].…”