Curcio Daniel, Cané Alejandro, Fernández Francisco Andrés, Correa Jorge
Vaccines Emerging Markets, Pfizer Inc, Buenos Aires, Argentina.
Content Medicine, Buenos Aires, Argentina.
Infect Dis Ther. 2019 Mar;8(1):87-103. doi: 10.1007/s40121-019-0231-8. Epub 2019 Jan 18.
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.
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.
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).
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.
Pfizer Inc.
艰难梭菌感染在全球范围内的患病率正在迅速上升，但在意识、诊断资源和监测方案有限的发展中国家，患病率难以估计。由于腹泻是标志性症状，我们进行了一项系统评价和荟萃分析，以确定这些地区出现腹泻的患者中艰难梭菌感染的患病率和发病率。
我们对MEDLINE/PubMed、Scopus以及拉丁美洲和加勒比健康科学文献数据库进行了系统的文献检索，以识别和分析近期研究的数据，这些研究提供了四个地区（非洲-中东、发展中亚洲、拉丁美洲和中国）发展中国家艰难梭菌相关性腹泻的患病率或发病率。我们的目标是确定发展中国家艰难梭菌相关性腹泻首次发作的当前患病率和发病密度率。
在我们分析纳入的地区中，腹泻患者中艰难梭菌感染的患病率为15%（95%置信区间13%-17%）（包括社区患者和住院患者），各地区之间无显著差异。17项包含此信息的研究中，艰难梭菌感染的发病率为每10000患者日8.5例（95%置信区间5.83-12.46）。住院患者的患病率显著高于社区患者（p = 0.0227）。
我们估计的15%的患病率令人担忧；然而，意识淡薄以及诊断和监测方案不一致表明这一数字被明显低估。应加强对腹泻患者艰难梭菌感染的认识和管理，同时改进感染控制和监测措施，以降低发展中国家艰难梭菌相关性腹泻的患病率。
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