Evidence map›Paper›PMID 41933426›Full record

SynthesisAntimicrobial resistance and infection control2026

Impact of the COVID-19 pandemic on the incidence of Clostridioides difficile infection based on hospital surveillance data: a systematic review and meta-analysis.

Yi Zhao, Xuan He, Yifan Hu, Rui Su, Xinyao Liu, Dazhi Jin, Lilu Ding, Yu Chen

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in Antimicrobial resistance and infection control, 2026. 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. Twenty-Five-Year Trends in Mortality Associated withMedical sciences (Basel, Switzerland) · 2026
    Article
  2. Influence of COVID-19 on Clinical Outcomes ofAntibiotics (Basel, Switzerland) · 2026
    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

8 authors.

Yi ZhaoSchool of Clinical Medicine, Hangzhou Medical College, Hangzhou, People's Republic of China.
Xuan HeDepartment of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou, China.
Yifan HuDepartment of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou, China.
Rui SuDepartment of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou, China.
Xinyao LiuDepartment of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou, China.
Dazhi JinSchool of Laboratory Medicine, Hangzhou Medical College, Zhejiang, People's Republic of China.
Lilu DingDepartment of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou, China. L.ding@hmc.edu.cn.
Yu ChenSchool of Laboratory Medicine, Hangzhou Medical College, Zhejiang, People's Republic of China. ychen@hmc.edu.cn.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundClostridioides difficile infection (CDI) remains a substantial burden on healthcare systems worldwide. The COVID-19 pandemic has had profound and multifaceted effects on healthcare delivery and infection control practices, potentially influencing the epidemiology of CDI.

objectiveTo assess whether the coronavirus disease 2019 (COVID-19) pandemic has influenced the incidence of CDI and to explore potential contributing factors.

methodsThis systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Seven databases were searched for relevant literature published from December 2019 to October 2025. Study quality was assessed via the Newcastle‒Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal tools. Random- or fixed-effects models were selected according to heterogeneity. Publication bias was evaluated via funnel plots and Egger's test, and sensitivity analyses were conducted. The primary outcome was the incidence rate of CDI, expressed as cases per 10,000 patient-days. Incidence rate ratios (IRR) were calculated to compare the incidence of CDI between the prepandemic and pandemic periods.

resultsSixteen studies were included. The pooled CDI incidence rate was 4.42 (95% CI: 3.37-5.46) per 10,000 patient-days in the prepandemic period and 3.80 (95% CI: 2.63-4.96) per 10,000 patient-days during the pandemic. The pooled incidence rate ratio was 0.80 (95% CI: 0.67-0.97), indicating a significant reduction in the incidence of CDI. This decline was associated with changes in medical practices (e.g., the suspension of nonurgent and high-risk procedures), antimicrobial stewardship practices, and strengthened infection control measures (e.g., enhanced hand hygiene and environmental disinfection) during the pandemic.

conclusionCompared with the prepandemic period, the incidence of CDI decreased significantly during the COVID-19 pandemic. This finding suggests that strengthened infection prevention measures, improved antimicrobial stewardship, and adaptations in healthcare delivery may have contributed to reduced CDI transmission. Reinforcing these evidence-based foundational strategies may help mitigate ‌the risk of CDI and other healthcare-associated infections during future public health emergencies.

Indexed as

Clostridioides difficileClostridium InfectionsCOVID-19Cross InfectionHospitalsHumansIncidenceInfection ControlPandemicsSARS-CoV-2Antimicrobial stewardshipClinical practiceClostridioides difficile infectionCOVID-19 pandemicInfection control

Identifiers

PMID41933426
PMCPMC13173910

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

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.