title: The risk of Clostridium difficile associated diarrhea in nasogastric tube insertion: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Clostridium difficile-associated diarrhea (CDAD) is a major concern of public health worldwide. The risk of CDAD in patients with nasogastric tube (NGT) insertion is controversial. The aim of this study was to assess the risk of incidence of CDAD in patients with NGT insertion.
  
  
  METHODS
  A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception through August 2015. Studies that reported relative risks, odds ratios, or hazard ratios comparing the risk of CDAD in patients with NGT insertion versus those who did not were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
  
  
  RESULTS
  Eleven observational studies were included in our analysis to assess the association between NGT insertion and risk of CDAD. The pooled RR of CDAD in patients with NGT insertion was 1.87 (95% CI, 1.06-3.28, I(2)=73). When meta-analysis was limited only to cohort and case-control studies, the pooled RR of CDAD was 1.99 (95% CI, 1.05-3.77, I(2)=76).
  
  
  CONCLUSIONS
  Our study demonstrated a statistically significant association between NGT insertion and risk of CDAD. This finding may impact clinical management and primary prevention of CDAD.
authors.affiliation: Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA. Electronic address: dr.karn.wi@gmail.com.
authors.forename: Karn
authors.initials: K
authors.lastname: Wijarnpreecha
authors.affiliation: Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA.
authors.forename: Suthanya
authors.initials: S
authors.lastname: Sornprom
authors.affiliation: Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Parkpoom
authors.initials: P
authors.lastname: Phatharacharukul
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
authors.forename: Wisit
authors.initials: W
authors.lastname: Cheungpasitporn
authors.affiliation: Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Nakkala
mesh_terms: D016360:Clostridioides difficile; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000150:complications*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D016017:Odds Ratio; D012307:Risk Factors
keywords: Clostridium difficile associated diarrhea; Clostridium difficile infection; Meta-analysis; Nasogastric tube