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Trends in Clostridioides difficile infection prevalence among pediatric cancer patients: A systematic review and
Muluneh Assefa1, Sirak Biset1, Azanaw Amare1
1Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Insights
Clostridioides difficile infection (CDI) affects 15.41% of pediatric cancer patients globally. Early detection and targeted treatment are crucial to reduce severe complications and mortality in this vulnerable population.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Epidemiology
Background:
- Pediatric cancer patients face a high risk of Clostridioides difficile infection (CDI) due to factors like immunosuppression, extended hospital stays, and antibiotic use.
- This systematic review and meta-analysis addresses the global prevalence of CDI in this specific patient group.
Purpose of the Study:
- To determine the global pooled prevalence of Clostridioides difficile infection (CDI) among pediatric cancer patients.
- To identify potential sources of heterogeneity in CDI prevalence across studies.
Main Methods:
- A systematic review and meta-analysis was conducted following PRISMA guidelines, including 20 articles published between 1985 and 2024.
- Data were analyzed using a random-effects model, with heterogeneity assessed via I2 statistic and Galbraith plots.
- Publication bias was evaluated using Egger's test and funnel plots; subgroup and meta-regression analyses were performed.
Main Results:
- The pooled prevalence of CDI in pediatric cancer patients was 15.41% (95% CI: 10.57-20.24%), with significant heterogeneity (I2 = 99.90%, p < 0.001).
- Prevalence varied significantly by region and study type, with higher rates observed in Asia (23.23%) and prospective studies (20.64%).
- Continent and sample size were identified as significant sources of heterogeneity.
Conclusions:
- A substantial global burden of CDI exists among pediatric cancer patients, underscoring the need for vigilant surveillance.
- Targeted detection and treatment strategies, including addressing drug-resistant strains, are essential to mitigate severe outcomes and mortality in this population.
Introduction:
Pediatric cancer patients are highly susceptible to Clostridioides difficile infection (CDI) due to immunosuppression, prolonged hospitalization, and antibiotic exposure. This study determined the global pooled prevalence of CDI among pediatric cancer patients.
Methods:
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 20 available articles published between 1985 and 2024 were included in this study. The extracted data from the relevant articles were analyzed using STATA version 17.0. The effect size estimate was computed using a random-effects model, considering a 95% confidence interval. The I2 statistic and Galbraith plot were used to confirm heterogeneity. Univariate meta-regression, sensitivity, and subgroup analyses were conducted to identify the source of heterogeneity. Egger's test and a funnel plot were used to check for publication bias.
Results:
The pooled prevalence of CDI was 15.41% (95% CI: 10.57-20.24%), with high heterogeneity (I2 = 99.90%) and statistical significance (p < 0.001). The trend in the study year was a minimum prevalence of 0.96% in 2016-2020 (Brazil) and a maximum prevalence of 38.26% in 2007-2017 (USA). In the subgroup analysis, a relatively high prevalence of CDI was observed in Asia (23.23%; 95% CI: 17.44-29.01%) and prospective studies (20.64%; 95% CI: 14.25-27.03%), and studies included pediatric patients with hematologic, solid tumors, and hematopoietic stem cell transplantation recipients (18.34%; 95% CI: 8.05-28.63%). The test of group differences (p < 0.001) in the continent in subgroup analysis and sample size (p = 0.049) in univariate meta-regression were sources of heterogeneity between the effect sizes of the individual studies.
Conclusion:
There is a significant burden of CDI in pediatric cancer patients. These findings highlight the need for regular detection and targeted treatment of CDI, including drug-resistant strains, in cancer patients to minimize severe complications and mortality.
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