# The global burden and trend of Clostridioides difficile and its association with world antibiotic consumption, 1990–2019

## TL;DR

This study shows that Clostridioides difficile infections have increased globally since 1990, especially in high-income regions, and are strongly linked to antibiotic use.

## Contribution

The paper provides the first comprehensive global analysis of Clostridioides difficile burden and its correlation with antibiotic consumption from 1990 to 2019.

## Key findings

- CDI is the leading cause of diarrheal deaths and disability-adjusted life years among 13 pathogens.
- Antibiotic consumption is positively correlated with CDI rates across different regions.
- High to middle-SDI regions like North America and Latin America show the fastest increase in CDI death rates.

## Abstract

To estimate the global trends and disease burden of Clostridioides difficile infection (CDI) and its correlation with worldwide antibiotic consumption.

Clostridioides difficile infection and antibiotic consumption data were retrieved from the Global Burden of Disease 2019, ResistanceMap-AntibiocUse, Food and Drug Administration (FDA) Adverse Event Reporting System, and Global Antimicrobial Resistance and Use Surveillance System. Jointpoint regression and age-period-cohort model were developed to show the global trends and burden of CDI. Correlation tests were calculated to explore the relationship between CDI and antibiotics.

Globally, CDI is the most significant one with a high-rocketing burden increase rate among 13 pathogens causing diarrheal deaths and disability-adjusted life years (DALYs). The age-standardised death rate (ASDR) increased from 0.19 in 1990 to 0.43 in 2019, in which the elderly and females are at higher risk. A rapid increase in ASDR in high to middle sociodemographic index (SDI) regions such as North America (average annual percentage change (AAPC) = 7.71%), Andean (AAPC = 7.82%), and Southern Latin America (AAPC = 11.08%) was identified. Antibiotic consumption has a significant positive correlation with CDI with different risk stratifications.

The global burden of CDI has continuously increased for the past 30 years, especially in high to middle-SDI regions. World antibiotic consumption showed a strong positive correlation with CDI with different risk stratification. More effective prevention and control measures should be implemented in these critical regions, with a specific emphasis on vulnerable populations, to mitigate the spread of epidemics.