Prevalence and molecular characterization of Clostridioides difficile infection in China over the past 5 years: a systematic review and meta-analysis

•Assessed the prevalence of Clostridioides difficile infection and toxigenic C. difficile in China.•The main genotypes of C. difficile in China were ST54, ST3, and ST37.•The main genotypes of C. difficile in northern and southern China were different.•The most prevalent genotype of C. difficile in northern China was ST2.•The surveillance and management of C. difficile infection should continue to be strengthened. The aim of this study was to provide an overview of the prevalence and molecular characteristics of Clostridioides difficile infection (CDI) in China in the past 5 years. A systematic literature review was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Nine databases were searched for relevant studies published between January 2017 and February 2022. The Joanna Briggs Institute critical appraisal tool was used to assess the quality of included studies, and R software version 4.1.3 was used for data analysis. Funnel plots and Egger regression tests were also performed to assess publication bias. A total of 50 studies were included in the analysis. The pooled prevalence of CDI in China was 11.4% (2696/26,852). The main circulating C. difficile strains in southern China were ST54, ST3, and ST37, consistent with the overall situation in China. However, the most prevalent genotype in northern China was ST2, which was previously underappreciated. Based on our findings, increased awareness and management of CDI is necessary to reduce the prevalence of CDI in China.