title: 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).
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China.
authors.forename: Chenjie
authors.initials: C
authors.lastname: Tang
authors.affiliation: Key Laboratory of Enteric Pathogenic Microbiology of Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, P.R. China.
authors.forename: Lunbiao
authors.initials: L
authors.lastname: Cui
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China.
authors.forename: Yuqiao
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China.
authors.forename: Le
authors.initials: L
authors.lastname: Xie
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Sun
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China.
authors.forename: Chengcheng
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China.
authors.forename: Wenying
authors.initials: W
authors.lastname: Xia
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China.
authors.forename: Genyan
authors.initials: G
authors.lastname: Liu
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002681:China / Q000453:epidemiology; D002939:Ciprofloxacin / Q000494:pharmacology; D002981:Clindamycin / Q000494:pharmacology; D016360:Clostridioides difficile / Q000145:classification* / Q000187:drug effects; D003015:Clostridium Infections / Q000453:epidemiology*; D024881:Drug Resistance, Bacterial; D004917:Erythromycin / Q000494:pharmacology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002939:Ciprofloxacin; D004917:Erythromycin