Abstract
Hematopoietic stem cell transplant (HSCT) recipients are vulnerable to Clostridium difficile infection (CDI) due to risk factors such as immunosuppression, antimicrobial use, and frequent hospitalization. We systematically searched PubMed and Embase to screen relevant studies from April 2014 to November 2021. A meta-analysis was performed to identify the association between CDI and hematopoietic transplantation based on the standard mean difference and 95% confidence intervals (CIs). Among the 431 retrieved citations, we obtained 43 eligible articles, which included 15,911 HSCT patients at risk. The overall estimated prevalence of CDI was 13.2%. The prevalence of CDI among the 10,685 allogeneic transplantation patients (15.3%) was significantly higher than that among the 3,840 autologous HSCT recipients (9.2%). Different incidence rates of CDI diagnosis over the last 7 years were found worldwide, of which North America (14.1%) was significantly higher than Europe (10.7%) but not significantly different from the prevalence among Asia (11.6%). Notably, we found that the estimated prevalence of CDI diagnosed by polymerase chain reaction (PCR) (17.7%) was significantly higher than that diagnosed by enzyme immunoassay (11.5%), indicating a significant discrepancy in the incidence rate of CDI owing to differences in the sensibility and specificity of the detection methods. Recurrence of CDI was found in approximately 15% of the initial patients with CDI. Furthermore, 20.3% of CDI cases were severe. CDI was found to be a common complication among HSCT recipients, displaying an evident increase in the morbidity of infection.
Highlights
Clostridium difficile infections (CDI) remain the leading cause of infectious diarrhea among hospitalized patients across the world
Further analyses were performed for the estimated prevalence of CDI patients from 1998 to 2010 and from 2011 to 2021; the results showed that the estimated prevalence of CDI in 1998–2010 patients was 10.1%, which was significantly lower than that of the 2011–2021 patients [13.0%, p < 0.01] (Supplementary Figure 9)
CDI has been increasingly discerned among Hematopoietic stem cell transplant (HSCT) recipients because of the fragility of the immune system, graft-versus-host disease (GVHD), and antibiotic usage or prophylaxis (Ilett et al, 2019; Rosignoli et al, 2020; Jabr et al, 2021)
Summary
Clostridium difficile infections (CDI) remain the leading cause of infectious diarrhea among hospitalized patients across the world. Patients with hematologic malignancies— those who undergo hematopoietic stem cell transplants (HSCT)—are at risk of developing CDI because of prolonged hospital stay, exposure to broad-spectrum antibiotics, and compromise of the gastrointestinal mucosal barrier ( (Alonso et al, 2013; Shah et al, 2017). An earlier systematic review of published literature until 2014 showed that the pooled prevalence of CDI among 12,025 HSCT patients was 7.9%, and an increasing trend of CDI diagnosis was found worldwide and across studies conducted in North America over the last 34 years (Zacharioudakis et al, 2014). This study evaluated and updated the epidemiology of CDI in the hematopoietic transplantation setting from April 2014 to November 2021
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