Angulo FJ, Zhao G, Yuan W, Yin Z, Yang J, Khan S, Tran D, Gonzalez EN, Sun A, Shen S, Findlow J. Systematic literature review of the Clostridioides Difficile Infection (CDI) disease burden in mainland China. Poster presented at the 9th International C. difficile Symposium; September 8, 2026. Bled, Slovenia.

BACKGROUND AND AIMS: Clostridioides difficile infection (CDI) is an important cause of morbidity and mortality worldwide. In many countries, CDI is a leading cause of healthcare-associated infections and an increasing cause of community-associated infections. There is limited information, however, on CDI disease burden in China. Hospital-based studies in Hong Kong reported a population-based hospitalized CDI incidence comparable to that observed in the United States, but public health surveillance for CDI is not conducted in China and the CDI disease burden is not well defined in mainland China. We conducted a systematic literature review to better understand the available data on CDI disease burden in mainland China.

METHODS: Three global (MEDLINE including using PubMed, Embase, and Cochrane) and three Chinese (National Knowledge Infrastructure, Science Citation, Wanfang) databases were searched in August 2025 using CDI-related and epidemiological search terms with no date or language limits. Outcomes of interest for CDI disease burden in mainland China, abstracted or calculated from the available studies, included hospital-based CDI incidence (cases per 10,000 patient-days), population-based CDI incidence (cases per 100,000 persons per year), and CDI admission rates (cases per 1,000 admissions).

RESULTS: Searches yielded 563 unique articles. Following the exclusion of 547 (97.2%) in accordance with the exclusion criteria, 16 articles were assessed at the full text review level, of which 11 articles reported outcomes of interest. The 11 articles were published between 2014-2023 and were each a single-hospital study; the studies were conducted in six cities in mainland China (map). While none of the studies reported population-based CDI incidence, 10 (90.9%) studies reported hospital-based CDI incidence, and 4 (36.4%) reported CDI admission rates. The reported hospital-based CDI incidence ranged from 0.2-58.0/10,000 patient-days and the CDI admission rate ranged from 0.2-10.0/1,000 admissions.

CONCLUSION: A limited number of studies demonstrate the presence of CDI in hospitals in mainland China but there are no published estimates of population-based CDI incidence for mainland China. Future population-based studies are needed to quantify the CDI disease burden in mainland China and to guide prevention strategies aimed at reducing the CDI disease burden in China.