Evidence map›Paper›PMID 39920584›Full record

ArticleBMC infectious diseases2025

Abundant geographical divergence of Clostridioides difficile infection in China: a prospective multicenter cross-sectional study.

Lulu Bai, Telong Xu, Wenzhu Zhang, Yajun Jiang, Wenpeng Gu, Wei Zhao, Yang Luan, Yanfeng Xiong, Nianli Zou, Yalin Zhang and 4 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Burden of Clostridioides difficile infection in China, 1990-2021: an analysis based on the global burden of disease study 2021.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026
    Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Lulu BaiNational Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
Telong XuNational Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
Wenzhu ZhangNational Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
Yajun JiangNational Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
Wenpeng GuInstitute of Acute Infectious Disease Control and Prevention, Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan, 650500, China.
Wei ZhaoJilin Provincial Center for Disease Control and Prevention, Changchun, Jilin, 132001, China.
Yang LuanXi'an Municipal Center for Disease Control and Prevention, Xi'an, Shaanxi, 710061, China.
Yanfeng XiongGanzhou Center for Disease Control and Prevention, Ganzhou, Jiangxi, 341001, China.
Nianli ZouZigong Center for Disease Control and Prevention, Zigong, Sichuan, 643002, China.
Yalin ZhangHainan Provincial Center for Disease Control and Prevention, Haikou, Hainan, 570203, China.
Ming LuoYulin Center for Disease Control and Prevention, Yulin, Guangxi, 537006, China.
Jinxing LuNational Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
Bike ZhangNational Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
Yuan WuNational Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China. wuyuan@icdc.cn.

Funding

This study was supported by the National Key Research and Development Program of China 2023YFC2308800
6 · The paper itself

Abstract

Clostridioides difficile is the predominant pathogen in hospital-acquired infections and antibiotic-associated diarrhea. Dedicated networks and annual reports for C. difficile surveillance have been established in Europe and North America, however the extensive investigation on the prevalence of C. difficile infection (CDI) in China is limited. In this study, 1528 patients with diarrhea were recruited from seven geographically representative regions of China between July 2021 and July 2022. The positivity rate of toxigenic C. difficile using real-time fluorescence quantitative PCR test of feces was 10.2% (156/1528), and 125 (8.2%, 125/1528) strains were successfully isolated. The isolates from different geographical areas had divergent characteristics after multilocus sequence typing, toxin gene profiling, and antimicrobial susceptibility testing. No isolate from clade 2 were found, and clade 1 was still the main clade for these clinical isolates. Interestingly, clade 4, especially ST37, previously known as the characteristic type of China, showed a strong geographical divergence. Clade 3, although rare in China, has been detected in Hainan and Sichuan provinces. Most C. difficile isolates (76.8%, 96/125) were toxigenic. Clindamycin, erythromycin, and moxifloxacin were the top three antibiotics to which resistance was observed, with resistance rates of 81.3%, 63.6%, and 24.0%, respectively. Furthermore, 34 (27.2%, 34/125) multidrug-resistant (MDR) strains were identified. All the strains were sensitive to metronidazole, vancomycin, and meropenem. The genotype of C. difficile varies greatly among the different geographical regions in China, and new types are constantly emerging. Therefore, comprehensive, longitudinal, and standardized surveillance of C. difficile infections is needed in China, covering typical geographical areas.

Indexed as

Clostridioides difficileClostridium InfectionsAdultAgedAged, 80 and overAnti-Bacterial AgentsChinaCross-Sectional StudiesDiarrheaFecesFemaleHumansMaleMicrobial Sensitivity TestsMiddle AgedMultilocus Sequence TypingAnti-Bacterial AgentsAntimicrobial susceptibilityClostridioides difficile infectionsMolecular epidemiologyMultilocus sequence typingToxin gene profile

Identifiers

PMID39920584
PMCPMC11806848

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.