# Trends in Clostridioides difficile infection prevalence among pediatric cancer patients: A systematic review and meta-analysis

## TL;DR

This study finds that about 15% of pediatric cancer patients globally are affected by Clostridioides difficile infection, with significant variation across regions and study types.

## Contribution

The study provides the first global pooled prevalence estimate of CDI in pediatric cancer patients using a systematic review and meta-analysis.

## Key findings

- The global pooled prevalence of CDI among pediatric cancer patients is 15.41% with high heterogeneity.
- CDI prevalence varied significantly by region, with the highest in Asia at 23.23%.
- Subgroup analyses showed higher CDI prevalence in prospective studies and in patients with hematologic conditions.

## Abstract

Pediatric cancer patients are highly susceptible to Clostridioides difficile infection (CDI) due to immunosuppression, prolonged hospitalization, and antibiotic exposure. This study determined the global pooled prevalence of CDI among pediatric cancer patients.

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 20 available articles published between 1985 and 2024 were included in this study. The extracted data from the relevant articles were analyzed using STATA version 17.0. The effect size estimate was computed using a random-effects model, considering a 95% confidence interval. The I2 statistic and Galbraith plot were used to confirm heterogeneity. Univariate meta-regression, sensitivity, and subgroup analyses were conducted to identify the source of heterogeneity. Egger’s test and a funnel plot were used to check for publication bias.

The pooled prevalence of CDI was 15.41% (95% CI: 10.57–20.24%), with high heterogeneity (I2 = 99.90%) and statistical significance (p < 0.001). The trend in the study year was a minimum prevalence of 0.96% in 2016–2020 (Brazil) and a maximum prevalence of 38.26% in 2007–2017 (USA). In the subgroup analysis, a relatively high prevalence of CDI was observed in Asia (23.23%; 95% CI: 17.44–29.01%) and prospective studies (20.64%; 95% CI: 14.25–27.03%), and studies included pediatric patients with hematologic, solid tumors, and hematopoietic stem cell transplantation recipients (18.34%; 95% CI: 8.05–28.63%). The test of group differences (p < 0.001) in the continent in subgroup analysis and sample size (p = 0.049) in univariate meta-regression were sources of heterogeneity between the effect sizes of the individual studies.

There is a significant burden of CDI in pediatric cancer patients. These findings highlight the need for regular detection and targeted treatment of CDI, including drug-resistant strains, in cancer patients to minimize severe complications and mortality.