CDI Prevalence in China Reflective of Worldwide Rates

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The prevalence of CDI in southern China was 11.0% and 13.6% in northern China.

Similar to what is happening worldwide, rates of clostridiodes difficile infections (CDI) in China are relatively high in China between 2017-2022.1

A team, led by Bao-Jiang Wen, The Second Hospital of Hebei Medical University, identified the prevalence and molecular characteristics of CDI in China over the past 5 years.

The Reason

CDI has greatly increased worldwide in recent years, largely due to the widespread use of broad-spectrum antibiotics.

“In the 21st century, a highly virulent ribotype 027 C. difficile strain emerged and spread widely in North America and Europe, resulting in high outbreaks, recurrence rates, and mortality,” the authors wrote. “In Asia, the epidemiology of CDI is largely under-investigated due to insufficient awareness of CDI in many hospitals, resulting in limited recent comprehensive epidemiological data. However, proper nosocomial infection control and long-term epidemiological surveillance are essential for better prevention and management of CDI.”

Reviewing the Data

In the systematic literature review, the investigators searched 9 databases for relevant studies on CDI in China between January 2017 and February 2022.

Each study was assessed for quality using the Joanna Briggs Institute critical appraisal took and performed funnel plots and Egger regression tests to assess publication bias.

Overall, they identified 1149 studies and included 50 studies in the final analysis.

The 50 studies come from 16 provinces, including from Zhejiang (n = 16), Beijing (n = 6), and Shanghai (n = 6). In addition, 12 studies were classified in northern China and 36 took place in southern China.

Prevalence Rates

CDI was diagnosed in 2696 patients in 33 studies with a total of 26.852 participants.

The results show a pooled prevalence of CDI in China of 11.4% (95% confidence interval [CI], 9.1%–13.9%). There was a high level of heterogeneity between the estimated rates (I2= 93.9%; P <0.001).

Chongqing (31.1%; 95% CI, 23.1%–40.2%) and Jiangsu (18.9%; 95% CI, 9.8%–30.0%) had the highest prevalence rates of CDI among the provinces.

On the other hand, Shanghai (5.8%; 95% CI, 2.1%–11.3%) and Ningxia (6.8%; 95% CI, 4.8%–9.3%) had the lowest prevalence rates of CDI among the provinces.

The prevalence of CDI in southern China was 11.0% (95% CI, 8.4%–13.8%) and 13.6% (95% CI, 9.4%–18.5%) in northern China.

In southern China, the main circulating strains of C difficile were ST54, ST3, and ST37.

This is consistent with the overall prevalence of strains in China. However, in northern China, the most prevalent genotype was ST2, which was previously underappreciated.

“Based on our findings, increased awareness and management of CDI is necessary to reduce the prevalence of CDI in China,” the authors wrote.


Wen, B.-J., Dong, N., Ouyang, Z.-R., Qin, P., Yang, J., Wang, W.-G., Qiang, C.-X., Li, Z.-R., Niu, Y.-N., & Zhao, J.-H. (2023). Prevalence and molecular characterization of Clostridioides difficile infection in China over the past five years: A systematic review and meta-analysis. International Journal of Infectious Diseases.