Importance Detection of Clostridioides difficile has frequently been described in asymptomatic infants and children, but accurate estimates across the age spectrum are unavailable. Objective To assess the prevalence of C difficile detection among asymptomatic children across the age spectrum. Data Sources This systematic review and meta-analysis included a search of the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Scopus, and Web of Science for articles published from January 1, 1990, to December 31, 2020. Search terms included Clostridium difficile, Peptoclostridium difficile, Clostridioides difficile, CDF OR CDI OR c diff OR c difficile, Clostridium infections OR cd positive diarrhea OR cd positive diarrhea OR Clostridium difficile OR Peptoclostridium difficile OR pseudomembranous colitis OR pseudomembranous enterocolitis, enterocolitis, and pseudomembranous. These were combined with the following terms: bacterial colonization and colonization OR colonized OR colonizing OR epidemiology OR prevalence OR seroprevalence. Study Selection Studies were screened independently by 2 authors. Studies were included if they reported testing for C difficile among asymptomatic children (ie, children without diarrhea) younger than 18 years. Data Extraction and Synthesis Data were extracted independently and in duplicate by 2 reviewers. Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were used. Data were pooled using a random-effects model. Main Outcomes and Measures The primary outcome was prevalence of C difficile detection among asymptomatic children. Secondary outcomes included prevalence of toxigenic vs nontoxigenic strains of C difficile and prevalence of C difficile detection stratified by geographic region, income status, testing method, and year of testing. Results A total of 95 studies with 19 186 participants were included. Rates of detection of toxigenic or nontoxigenic C difficile were greatest among infants aged 6 to 12 months (41%; 95% CI, 32%-50%) and decreased to 12% (95% CI, 7%-18%) among children aged 5 to 18 years. The prevalence of toxigenic C difficile colonization was lower, peaking at 14% (95% CI, 8%-21%) among infants aged 6 to 12 months and decreasing to 6% (95% CI, 2%-11%) among children older than 5 years. Although prevalence differed by geographic region (ie, North and South America vs Europe: β, -0.151, P = .001; North and South America vs Western Pacific: β, 0.136, P = .007), there was no difference by testing method (ie, culture vs polymerase chain reaction: β, 0.069, P = .052; culture vs enzyme immunoassay: β, -0.178, P = .051), income class (low-middle income vs high income: β, -0.144, P = .23; upper-middle vs high income: β, -0.020, P = .64), or period (before 1990 vs 2010-2020: β, -0.125, P = .19; 1990-1999 vs 2010-2020: β, -0.037, P = .42; 2000-2009 vs 2010-2020: β, -0.006, P = .86). Conclusions and Relevance In this systematic review and meta-analysis, C difficile colonization rates among children were greatest at 6 to 12 months of age and decreased thereafter. These estimates may provide context for interpreting C difficile test results among young children.

中文翻译：

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无症状儿童中艰难梭菌检测的患病率：系统评价和荟萃分析。

艰难梭菌检测的重要性经常在无症状婴儿和儿童中进行描述，但无法获得跨年龄范围的准确估计。目的 评估跨年龄段无症状儿童艰难梭菌检测的流行率。数据来源 本系统评价和荟萃分析包括在 Cochrane Central Register of Controlled Trials、MEDLINE、Embase、CINAHL、Scopus 和 Web of Science 中搜索 1990 年 1 月 1 日至 2020 年 12 月 31 日发表的文章。包括艰难梭菌、艰难梭菌、艰难梭菌、CDF OR CDI OR c diff OR c difficile，梭状芽胞杆菌感染或 cd 阳性腹泻或 cd 阳性腹泻或艰难梭菌或艰难梭菌或伪膜性结肠炎或伪膜性小肠结肠炎、小肠结肠炎和伪膜性。这些与以下术语相结合：细菌定植和定植或定植或定植或流行病学或流行或血清流行率。研究选择 研究由 2 位作者独立筛选。如果研究报告在 18 岁以下无症状儿童（即没有腹泻的儿童）中进行艰难梭菌检测，则纳入研究。数据提取和综合 数据由 2 位评审员独立提取，一式两份。使用了系统评价和荟萃分析 (PRISMA) 指南的首选报告项目。使用随机效应模型汇总数据。主要结果和措施 主要结果是无症状儿童中艰难梭菌检测的流行率。次要结果包括产毒与非产毒艰难梭菌菌株的流行率，以及按地理区域、收入状况、检测方法和检测年份分层的艰难梭菌检测流行率。结果共纳入95项研究，19 186名受试者。产毒或非产毒艰难梭菌的检出率在 6 至 12 个月的婴儿中最高（41%；95% CI，32%-50%），在儿童中降至 12%（95% CI，7%-18%）年龄 5 至 18 岁。产毒艰难梭菌定植率较低，在 6 至 12 个月的婴儿中最高为 14%（95% CI，8%-21%），在儿童中降至 6%（95% CI，2%-11%） 5 岁以上。尽管患病率因地理区域而异（即北美和南美与欧洲：β，-0.151，P = .001；北美和南美与西太平洋：β，0.136，P = .007），但通过测试没有差异方法（即培养与聚合酶链反应：β，0.069，P = .052；培养与酶免疫测定：β，-0.178，P = .051），收入阶层（中低收入与高收入：β，-0.144 ，P = .23；中高收入与高收入：β，-0.020，P = .64）或时期（1990 年前与 2010-2020 年：β，-0.125，P = .19；1990-1999 与 2010- 2020：β，-0.037，P = .42；2000-2009 与 2010-2020：β，-0.006，P = .86）。结论和相关性 在这项系统评价和荟萃分析中，儿童艰难梭菌定植率在 6 至 12 个月大时最高，此后下降。