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Text
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<a href="http://doi.org/10.3389/fmed.2020.00009" target="_blank" rel="noreferrer noopener">http://doi.org/10.3389/fmed.2020.00009</a>
Pages
9
Volume
7
ISSN
2296-858X 2296-858X
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<a href="http://neomed.idm.oclc.org/login?url=http://doi.org/10.3389/fmed.2020.00009" target="_blank" rel="noreferrer noopener">NEOMED Full-text Holding (if available) - Proxy DOI: 10.3389/fmed.2020.00009</a>
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Update Year & Number
June 2020 Update I
NEOMED College
NEOMED College of Medicine
NEOMED Department
NEOMED Student Publications
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Title
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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.
Publisher
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Frontiers in medicine
Date
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2020
1905-07
Subject
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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
Creator
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Rodriguez-Palacios Alexander; Mo Kevin Q; Shah Bhavan U; Msuya Joan; Bijedic Nina; Deshpande Abhishek; Ilic Sanja
Description
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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
Identifier
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<a href="http://doi.org/10.3389/fmed.2020.00009" target="_blank" rel="noreferrer noopener">10.3389/fmed.2020.00009</a>
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journalArticle
2020
antibiotic-resistance
Beef
Bijedic Nina
c
C. difficile
chicken meat
Contamination
Deshpande Abhishek
difficile
Epidemiology
fecal samples
Food
Frontiers in medicine
global
ground meat-products
Ilic Sanja
Journal Article
journalArticle
June 2020 Update I
Mo Kevin Q
Msuya Joan
NEOMED College of Medicine Student
NEOMED Student Publications
one health
resistant staphylococcus-aureus
retail meat
Rodriguez-Palacios Alexander
Shah Bhavan U
toxin genes
Vegetables