Global and Historical Distribution of Clostridioides difficile in the Human Diet (1981-2019): Systematic Review and Meta-Analysis of 21886 Samples Reveal Sources of Heterogeneity, High-Risk Foods, and Unexpected Higher Prevalence Toward the Tropic.
antibiotic-resistance; beef; c; C. difficile; chicken meat; contamination; difficile; epidemiology; fecal samples; food; global; ground meat-products; one health; resistant staphylococcus-aureus; retail meat; toxin genes; vegetables
Clostridioides difficile (CD) is a spore-forming bacterium that causes life-threatening intestinal infections in humans. Although formerly regarded as exclusively nosocomial, there is increasing genomic evidence that person-to-person transmission accounts for only <25% of cases, supporting the culture-based hypothesis that foods may be routine sources of CD-spore ingestion in humans. To synthesize the evidence on the risk of CD exposure via foods, we conducted a systematic review and meta-analysis of studies reporting the culture prevalence of CD in foods between January 1981 and November 2019. Meta-analyses, risk-ratio estimates, and meta-regression were used to estimate weighed-prevalence across studies and food types to identify laboratory and geographical sources of heterogeneity. In total, 21886 food samples were tested for CD between 1981 and 2019 (96.4%, n = 21084, 2007-2019; 232 food-sample-sets; 79 studies; 25 countries). Culture methodology, sample size and type, region, and latitude were sources of heterogeneity (p < 0.05). Although non-strictly-anaerobic methods were reported in some studies, and we confirmed experimentally that improper anaerobiosis of media/sample-handling affects CD recovery in agar (Fisher, p < 0.01), most studies (>72%) employed the same (one-of-six) culture strategy. Because the prevalence was also meta-analytically similar across six culture strategies reported, all studies were integrated using three meta-analytical methods. At the study level (n = 79), the four-decade global cumulative-prevalence of CD in the human diet was 4.1% (95%CI = -3.71, 11.91). At the food-set level (n = 232, mean 12.9 g/sample, similar across regions p > 0.2; 95%CI = 9.7-16.2), the weighted prevalence ranged between 4.5% (95%CI = 3-6%; all studies) and 8% (95%CI = 7-8%; only CD-positive-studies). Risk-ratio ranking and meta-regression showed that milk was the least likely source of CD, while seafood, leafy green vegetables, pork, and poultry carried higher risks (p < 0.05). Across regions, the risk of CD in foods for foodborne exposure reproducibly decreased with Earth latitude (p < 0.001). In conclusion, CD in the human diet is a global non-random-source of foodborne exposure that occurs independently of laboratory culture methods, across regions, and at a variable level depending on food type and latitude. The latitudinal trend (high
Rodriguez-Palacios Alexander; Mo Kevin Q; Shah Bhavan U; Msuya Joan; Bijedic Nina; Deshpande Abhishek; Ilic Sanja
Frontiers in medicine
2020
1905-07
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journalArticle
<a href="http://doi.org/10.3389/fmed.2020.00009" target="_blank" rel="noreferrer noopener">10.3389/fmed.2020.00009</a>
The Clinical Relevance Of Penicillin-resistant Streptococcus Pneumoniae: A New Perspective
antibiotic-resistance; bacteremia; community-acquired pneumonia; epidemiology; Immunology; Infectious Diseases; metaanalysis; Microbiology; molecular; mortality; outcomes; pneumococcal pneumonia; susceptibility; united-states
File T M; Tan J S; Boex J R
Clinical Infectious Diseases
2006
2006-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1086/500142" target="_blank" rel="noreferrer noopener">10.1086/500142</a>
Streptococcus Pneumoniae And Community-acquired Pneumonia: A Cause For Concern
antibiotic-resistance; antimicrobial resistance; bacteremic pneumococcal pneumonia; beta-lactam; fluoroquinolone resistance; General & Internal Medicine; macrolide resistance; penicillin resistance; respiratory-tract infections; risk-factors; united-states
File T M
American Journal of Medicine
2004
2004-08
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.amjmed.2004.07.007" target="_blank" rel="noreferrer noopener">10.1016/j.amjmed.2004.07.007</a>