{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:29:04Z","timestamp":1792636144830,"version":"4.5.0"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:00:00Z","timestamp":1642032000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p><jats:italic>Clostridium difficile<\/jats:italic> is the leading cause of infectious diarrhea that develops in patients after hospitalization during antibiotic administration. It has also become a big issue in community-acquired diarrhea. The emergence of hypervirulent strains of <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic> poses a major problem in hospital-associated diarrhea outbreaks and it is difficult to treat. The antimicrobial resistance in <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic> has worsened due to the inappropriate use of broad-spectrum antibiotics including cephalosporins, clindamycin, tetracycline, and fluoroquinolones together with the emergence of hypervirulent strains.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To estimate the pooled prevalence and antimicrobial resistance pattern of <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic> derived from hospitalized diarrheal patients, a systematic review and meta-analysis was performed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to review published studies conducted. We searched bibliographic databases from PubMed, Scopus, Google Scholar, and Cochrane Library for studies on the prevalence and antimicrobial susceptibility testing on <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic>. The weighted pooled prevalence and resistance for each antimicrobial agent was calculated using a random-effects model. A funnel plot and Egger\u2019s regression test were used to see publication bias.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 15 studies were included. Ten articles for prevalence study and 5 additional studies for antimicrobial susceptibility testing of <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic> were included. A total of 1967\/7852 (25%) <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic> were isolated from 10 included studies for prevalence study. The overall weighted pooled proportion (WPP) of <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic> was 30% (95% CI: 10.0\u201349.0; p&lt;0.001). The analysis showed substantial heterogeneity among studies (Cochran\u2019s test = 7038.73, I<jats:sup>2<\/jats:sup> = 99.87%; p&lt;0.001). The weighed pooled antimicrobial resistance (WPR) were: vancomycin 3%(95% CI: 1.0\u20134.0, p&lt;0.001); metronidazole 5%(95% CI: 3.0\u20137.0, p&lt;0.001); clindamycin 61%(95% CI: 52.0\u201369.0, p&lt;0.001); moxifloxacin 42%(95% CI: 29\u201354, p&lt;0.001); tetracycline 35%(95% CI: 22\u201349, p&lt;0.001); erythromycin 61%(95% CI: 48\u201375, p&lt;0.001) and ciprofloxacin 64%(95% CI: 48\u201380; p&lt; 0.001) using the random effect model.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A higher weighted pooled prevalence of <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic> was observed. It needs a great deal of attention to decrease the prevailing prevalence. The resistance of <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic> to metronidazole and vancomycin was low compared to other drugs used to treat <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic> infection. Periodic antimicrobial resistance monitoring is vital for appropriate therapy of <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic> infection.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0262597","type":"journal-article","created":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T19:21:11Z","timestamp":1642101671000},"page":"e0262597","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":36,"title":["Prevalence and antimicrobial resistance pattern of Clostridium difficile among hospitalized diarrheal patients: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3713-6783","authenticated-orcid":true,"given":"Tebelay","family":"Dilnessa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1608-6737","authenticated-orcid":true,"given":"Alem","family":"Getaneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Workagegnehu","family":"Hailu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feleke","family":"Moges","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baye","family":"Gelaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,1,13]]},"reference":[{"key":"pone.0262597.ref001","doi-asserted-by":"crossref","first-page":"2503","DOI":"10.1056\/NEJMe058221","article-title":"The new Clostridium difficile\u2014what does it mean?","volume":"353","author":"JG Bartlett","year":"2005","journal-title":"N Engl J Med"},{"issue":"8","key":"pone.0262597.ref002","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1046\/j.1198-743x.2001.00289.x","article-title":"Epidemiology of Clostridium difficile-associated infections","volume":"7","author":"F Barbut","year":"2001","journal-title":"Clin Microbiol Infect"},{"issue":"4","key":"pone.0262597.ref003","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1086\/659156","article-title":"Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile Infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals","volume":"32","author":"BA Miller","year":"2011","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"3","key":"pone.0262597.ref004","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.gerinurse.2007.04.005","article-title":"Clostridium difficile: An emerging epidemic in nursing homes","volume":"28","author":"NL Crogan","year":"2007","journal-title":"Geriatr Nurs"},{"issue":"6","key":"pone.0262597.ref005","first-page":"599","article-title":"Specific antisepsis and environmental disinfection in preventing Clostridium difficile associated diarrhea","volume":"21","author":"G Agolini","year":"2009","journal-title":"Ann Ig"},{"issue":"Suppl 3","key":"pone.0262597.ref006","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1002\/jhm.1916","article-title":"Clostridium difficile infection: the scope of the problem","volume":"7","author":"E. 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