Heterogeneity of Clostridioides difficile asymptomatic colonization prevalence: a systematic review and meta-analysis.

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Gut Pathogens Pub Date : 2025-01-27 DOI:10.1186/s13099-024-00674-0

Daniel De-la-Rosa-Martínez, Rodrigo Villaseñor-Echavarri, Diana Vilar-Compte, Virna Mosqueda-Larrauri, Paola Zinser-Peniche, Seth Blumberg

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Abstract

Background: Asymptomatic carriers significantly influence the transmission dynamics of C. difficile. This study aimed to assess the prevalence of toxigenic C. difficile asymptomatic colonization (tCDAC) and investigate its heterogeneity across different populations. We searched MEDLINE, Web of Science, and Scopus for articles published between 2000 and 2023 on tCDAC. Studies including asymptomatic adults with laboratory-confirmed tCDAC were eligible. We performed a random-effects meta-analysis to estimate the pooled prevalence by clinical characteristics, settings, and geographic areas. In addition, we used outlier analyses and meta-regression to explore sources of prevalence variability.

Results: Fifty-one studies involving 39,447 patients were included. The tCDAC prevalence ranged from 0.5 to 51.5%. Among pooled estimates, a high prevalence was observed in patients with cystic fibrosis, outbreak settings, and cancer patients, whereas the lowest rates were found in healthy individuals and healthcare workers. Similar colonization rates were observed between admitted and hospitalized patients. Our meta-regression analysis revealed lower rates in healthy individuals and higher rates in cystic fibrosis patients and studies from North America. Additionally, compared with that among healthy individuals, the prevalence significantly increased by 15-47% among different populations and settings.

Conclusion: Our study revealed that tCDAC is a common phenomenon. We found high prevalence estimates that showed significant variability across populations. This heterogeneity could be partially explained by population characteristics and settings, supporting their role in the pathogenesis and burden of this disease. This highlights the need to identify high-risk groups to improve infection control strategies, decrease transmission dynamics, and better understand the natural history of this disease.

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艰难梭菌无症状定植患病率的异质性：系统回顾和荟萃分析。

背景：无症状携带者显著影响艰难梭菌的传播动态。本研究旨在评估产毒素艰难梭菌无症状定植（tCDAC）的流行情况，并调查其在不同人群中的异质性。我们在MEDLINE、Web of Science和Scopus上检索了2000年至2023年在tCDAC上发表的文章。纳入实验室确诊的无症状成人tCDAC的研究符合条件。我们进行了随机效应荟萃分析，根据临床特征、环境和地理区域估计合并患病率。此外，我们使用异常值分析和元回归来探索患病率变异性的来源。结果：纳入51项研究，涉及39,447例患者。tCDAC患病率为0.5 ~ 51.5%。在汇总估计中，在囊性纤维化患者、爆发环境和癌症患者中观察到较高的患病率，而在健康个体和卫生保健工作者中发现的发病率最低。在住院患者和住院患者之间观察到相似的定植率。我们的荟萃回归分析显示，健康个体的发病率较低，而囊性纤维化患者和来自北美的研究的发病率较高。此外，与健康人群相比，不同人群和环境的患病率显著增加了15-47%。结论：本研究揭示了tCDAC是一种普遍现象。我们发现高流行率估计在人群中显示出显著的差异。这种异质性可以部分解释为人群特征和环境，支持其在该病发病机制和负担中的作用。这突出表明需要确定高危人群，以改进感染控制策略，减少传播动态，并更好地了解这种疾病的自然史。

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来源期刊

Gut Pathogens GASTROENTEROLOGY & HEPATOLOGY-MICROBIOLOGY

CiteScore

7.70

自引率

2.40%

发文量

期刊介绍： Gut Pathogens is a fast publishing, inclusive and prominent international journal which recognizes the need for a publishing platform uniquely tailored to reflect the full breadth of research in the biology and medicine of pathogens, commensals and functional microbiota of the gut. The journal publishes basic, clinical and cutting-edge research on all aspects of the above mentioned organisms including probiotic bacteria and yeasts and their products. The scope also covers the related ecology, molecular genetics, physiology and epidemiology of these microbes. The journal actively invites timely reports on the novel aspects of genomics, metagenomics, microbiota profiling and systems biology. Gut Pathogens will also consider, at the discretion of the editors, descriptive studies identifying a new genome sequence of a gut microbe or a series of related microbes (such as those obtained from new hosts, niches, settings, outbreaks and epidemics) and those obtained from single or multiple hosts at one or different time points (chronological evolution).