Clostridium difficile with Moxifloxacin/Clindamycin Resistance in Vegetables in Ohio, USA, and Prevalence Meta-Analysis

Figure 3

Systematic review and meta-analyses of C. difficile prevalence in vegetables for studies published between 1996 and 2014. (a) Forest plot of pooled meta-analysis with individual weighted estimates. Direct, MN, and CC indicate direct culture without enrichment, enrichment with moxalactam and norfloxacin (fluoroquinolone), or cycloserine/cefoxitin. With the inclusion of the Nigerian study [39], the study heterogeneity increased from low 7.7% to moderate 62.2% using cut off criteria as described [28]. Prior to its inclusion, the weighted overall prevalence of C. difficile was still very similar 2.3% (1.9, 2.6) to what is here reported with 6 studies. Asterisk: see methods for how zero prevalence studies were handled to enable the estimation of pooled parameters; study used direct contact culture plating on Brazier CCEY Agar as described in first report of C. difficile in vegetables [10]. (b) Cumulative meta-analysis depicting changing estimated prevalence trend as studies become available. Note the comparable homogeneity across studies and the similar overall weighted prevalence. The inclusion of the Nigerian study as described in methods [33] had little effect on final cumulative prevalence (2.3%, CI = 1.9, 2.8, before inclusion).

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