Clostridioides difficile Infection in Central Asia: Current Evidence, Molecular Epidemiology, and Surveillance Priorities-A Narrative Review.

Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated diarrhoea and a marker of antimicrobial exposure and healthcare quality, yet Central Asia is almost absent from the indexed literature. We reviewed available evidence on CDI epidemiology, antimicrobial use and molecular typing across Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan and Turkmenistan, searching PubMed/MEDLINE, Google Scholar and accessible regional sources, and identified priorities for surveillance development. The retrievable evidence is sparse and fragmented. The strongest direct data came from Uzbekistan, where paediatric cohorts documented toxigenic C. difficile in up to 47% of the aetiological structure of antibiotic-associated diarrhoea in early-aged children. Nationwide surveys in Kazakhstan showed substantial antimicrobial use (38.2-40.2% of inpatients) and measurable healthcare-associated infection burdens (2.4-3.8%), indicating environments in which CDI may go unrecognised. No national CDI surveillance, ribotyping or resistance-gene data were identified for any of the five countries, whereas evidence from China, Thailand and other Asian settings indicates that ribotype 017 (sequence type 37) predominates in those countries. This absence appears more consistent with underdiagnosis, fragmented reporting and limited laboratory capacity than with true absence of disease. Sentinel surveillance, standardised diagnostic algorithms, integration with antimicrobial stewardship and infection prevention programmes, and regional typing collaborations are the practical priorities.