Meta-Analysis to Identify the Predisposing Factors, Diagnosis, and Anti Microbial Therapy Guidelines for Clostridium difficile Infection

Abstract

The objective of current meta-analysis was to identify the predisposing factors, diagnostic, and anti microbial therapy guidelines for clostridium difficile infection. The methodology of this meta analysis involved the simple random sampling technique. Total 67 articles were selected and included for study i.e three decades (1988 uptil 2019). The results revealed significant drugs association and predisposing factors includes over use of antibiotics especially in immunosuppressed persons i.e 42.8% and 64.2% respectively. The common clinical presentations are temperature greater than 38°C (73.3%) and abdominal pain (53.3%). The lab diagnostic options includes WBCs ; ≥ 15,000 cell/μL (54.5%), albumin; ≤2.5 g/dL (54.5%), creatinine; ≥ 1.5 (54.5%), positive toxin assay (31.8%), and positive PCR including NAAT (27.2%) respectively. Next in sequence are the details for the complications i.e toxic megacolon (84.6%), hemodynamic instability (69.2%) and pseudo membarnous colitis (53.8%). In mild to moderate CDI, the drug of choice will be Metronidazole (45%). In severe cases, the drug of choice is a combination of metronidazole plus vancomycin (68%). For complicated cases the drug of choice is Fidaxomicin (31.8%). The conclusion revealed that CDI had strong association with over use of antibiotics and immunosuppression. Most common clinical presentations are the increased fever, abdominal pain and diarrhea. Increased WBCs, hypoalbuminemia, positive toxin assay and positive PCR are the lab diagnostic options. Metronidazole is a drug of choice for managing mild to moderate CDI. While in severe cases, the drug of choice can be a combination of metronidazole plus vancomycin.