Global and regional trends in Clostridioides difficile infection: An analysis from 1990 to 2021

The epidemiological situation of Clostridioides difficile infection (CDI) has dramatically changed over the past 30 years, but few studies have systematically analysed changes in the global epidemic landscape. This study aimed to delineate the global, regional, and national burden of CDI from 1990 to 2021.

CDI data were derived from the Global Burden of Disease Study 2021. Joinpoint regression analysis assessed changes over time and calculated annual percentage change (APC) statistics. An age-period-cohort model was adopted to estimate net/local drifts as well as the age, period, and cohort effects of CDI mortality. The relationship between the sociodemographic index (SDI) and antibiotic use and disease burden was analysed.

The age-standardised death rate (ASDR) increased from 0.10 per 100,000 persons in 1990 to 0.19 per 100,000 persons in 2021, with an estimated annual percentage change of 2.76 (95% confidence interval [CI]: 2.18, 3.33). The ASDR of global CDI exhibited an upward trend from 1990 to 2021, with an AAPC of 2.26 (95% CI: 1.77, 2.76), but a downward trend from 2017 to 2021, with an APC of -2.04 (95% CI: -3.17, -0.90). Antibiotic use was significantly positively associated with CDI burden. The defined daily dose of all antibiotic use per 1000 inhabitants was positively correlated with ASDRs in high, high-middle, and low SDI regions (P< 0.001, P < 0.001, and P< 0.001, respectively).

The burden of CDI has increased globally from 1990 to 2021, revealing significant spatial disparities. Antibiotic use is positively associated with CDI mortality.