Clostridioides difficile in Non-hospital Sources (Animals, Food, and Environment) in Asian Countries: A Literature Review

Context] Clostridioides difficile ( C. difficile ) is an agent responsible for severe infection with a high mortality rate in healthcare facilities. With the discovery of C. difficile in the community, it was assumed that this bacterium might be transmitted to humans through non-hospital sources.[Evidence Acquisition]This study examined different aspects of the epidemiology of C. difficile in Asian countries with a review of the literature using search engines such as Web of Science, Scopus, and PubMed.[Results]Based on the literature pertaining to Asia, the highest rate of C. difficile is found in samples collected from farm animals, red meat, and meatbased products. Two ribotypes 027 and 078, as hypervirulent factors, were found in different non-hospital sources. Resistance to the most frequently used antibiotics in healthcare setting was observed in C. difficile .[Conclusions]Due to the heterogeneity of the examination of C. difficile , understanding the actual condition of C. difficile is difficult. However, the presence of two hypervirulent ribotypes of C. difficile in non-hospital sources is alarming. It seems that it is necessary to perform further studies on C. difficile in non-hospital sources. Defining a focal point for such research could be helpful to explore the situation of C. difficile in clinical settings and communities of Asian countries.