■由于诊断设施和监测方案有限,在印度等发展中国家,艰难梭菌感染(CDI)的患病率数据很少。
■这些研究的目的是(1)确定印度CDI的患病率,(2)了解CDI的危险因素,(3)确定不同诊断方法对报告的CDI率的影响。
■使用PubMed和GoogleScholar数据库进行了系统的文献检索,以确定报告CDI患病率的印度研究。共31项研究,1990年至2020年发表的论文被纳入最终分析。卡方检验用于确定患病率之间的统计学显着关联,不同诊断方法的准确性,和CDI的抗生素使用率。
■CDI的患病率在3.4%至18%的范围内,各地区CDI患病率差异有统计学意义(P<.001)。使用抗生素,住院,合并症,最近的手术,质子泵抑制剂的使用被认为是CDI发展的危险因素.与其他地区相比,印度北部的抗生素使用率明显较高(P<.001)。在不同的诊断方法中,酶联免疫吸附试验的艰难梭菌检出率(18.02%)明显高于其他多种检测方法(P<.001)。
■在全国范围内,CDI负担很大。需要进一步的监测研究来监测CDI患病率的变化,危险因素,和诊断方法的准确性,以更好地了解印度的疾病负担。
BACKGROUND: Owing to limited diagnostic facilities and surveillance protocols, there is a paucity on the prevalence data of Clostridioides difficile infections (CDIs) in developing countries such as India.
OBJECTIVE: The aims of these studies are (1) to determine the prevalence of CDI in India, (2) to understand the risk factors of CDI, and (3) to determine the impact of different diagnostic methods on reported CDI rates.
METHODS: A systematic literature search was conducted using PubMed and Google Scholar database to identify Indian studies reporting the prevalence of CDI. A total of 31 studies, published between 1990 and 2020 were included in the final analysis. A chi-square test was used to determine statistically significant association between prevalence rates, accuracy of different diagnosis methods, and antibiotic usage rates of CDI.
RESULTS: The prevalence of CDI was in the range of 3.4% to 18%, and the difference between regional prevalence of CDI was statistically significant (P < .001). The use of antibiotics, hospital stay, comorbidities, recent surgery, and the use of proton-pump inhibitors was considered as risk factors for the development of CDI. Compared to other regions, the rate of antibiotic usage was significantly higher in North India (P < .001). Among different diagnostic methods, C. difficile detection was significantly higher with enzyme-linked immunosorbent assay (18.02%) versus other multiple testing methods used (P < .001).
CONCLUSIONS: There is a significant burden of CDI across the country. Further surveillance studies are required to monitor changes in prevalence of CDI, risk factors, and accuracy of diagnosis methods for a better understanding of the disease burden in India.