Prevalence of <i>Clostridioides difficile</i> contamination in healthcare and non-healthcare environments: a global systematic review and meta-analysis

Clostridioides difficile infection is a significant public health challenge. This study aimed to determine the overall prevalence of C. difficile contamination in healthcare and non-healthcare environments around the world from 2014 to 2024. In this systematic review, we searched five international databases. Random and fixed-effects models were used to estimate the pooled prevalence with 95% CIs. Among the 49 eligible studies and 20 779 environmental samples, 4507 samples were positive for C. difficile contamination. The overall prevalence was estimated as 0.26 (95% CI 0.23 to 0.28). The pooled prevalence according to the detection method was 0.26 (95% CI 0.21 to 0.32) and 0.62 (95% CI 0.50 to 0.74) using a culture test and PCR, respectively. The overall prevalence was 0.18 (95% CI 0.16 to 0.20) and 0.36 (95% CI 0.30 to 0.42) in the healthcare and non-healthcare environment, respectively. The prevalence in non-healthcare environments was 0.42, 0.38, 0.33 and 0.04 on farms, in public places, in the home and veterinary hospitals, respectively. The findings reveal a significant prevalence of C. difficile contamination across various environments worldwide. This alarming trend underscores the pressing need to prioritize environmental factors and implement effective disinfection strategies as part of comprehensive control programs aimed at tackling this disease.