Dynamics of toxigenic Clostridium perfringens colonisation in a cohort of prematurely born neonatal infants

Abstract

Background: Clostridium perfringens forms part of the human gut microbiota and has been associated with lifethreatening necrotising enterocolitis (NEC) in premature infants. Whether specific toxigenic strains are responsible is unknown, as is the extent of diversity of strains in healthy premature babies. We investigated the C. perfringens carrier status of premature infants in the neonatal intensive care unit, factors influence this status, and the toxic potential of the strains. Methods: C. perfringens was isolated by culture from faecal samples from 333 infants and their toxin gene profiles analysed by PCR. A survival analysis was used to identify factors affecting probability of carriage. Competitive growth experiments were used to explore the results of the survival analysis. Results: 29.4% of infants were colonized with C. perfringens before they left hospital. Three factors were inversely associated with probability of carriage: increased duration of maternal milk feeds, CPAP oxygen treatment and antibiotic treatment. C. perfringens grew poorly in breast milk and was significantly outperformed by Bifidobacterium infantis, whether grown together or separately. Toxin gene screening revealed that infants carried isolates positive for collagenase, perfringolysin O, beta 2, beta, becA/B, netB and enterotoxin toxin genes, yet none were observed to be associated with the development of NEC. Conclusions: Approximately a third of preterm infants are colonised 3 weeks after birth with toxin gene-carrying C. perfringens. We speculate that increased maternal breast milk, oxygen and antibiotic treatment creates an environment in the gut hostile to growth of C. perfringens. Whilst potentially toxigenic C. perfringens isolates were frequent, no toxin type was associated with NEC. Trial registration: clinicaltrials.gov NCT01102738, registered 13th April 2010.

Special Diets in Infants and Children and Impact on Gut Microbioma

“…These results are in agreement with a previous study on a cohort of infants up to 8 months of age, reporting a higher α-diversity in the SF-fed subjects [ 98 ]. In addition, a previously unidentified genus of Ruminococcaceae was enriched in the SF group compared to milk-based formula or BF groups at 3 months of age, and unidentified genera of the order Clostridiales were more numerous in the SF group than the other two at 6 and 9 months of age [ 97 ], confirming the data previously observed in the animal model [ 39 ]. Gastro-intestinal disorders may cause alterations in gut microbial diversity.…”

“…In conclusion, breastfeeding, mainly due to the presence of HMOs, promotes the colonization of beneficial bifidobacteria and is able to support immune system development and to prevent infections, as depicted in Figure 1 [ 8 , 23 , 36 , 37 , 38 ]. On the contrary, milk formulas have been correlated to the growth of opportunistic pathogens and to proteolytic gut metabolism, potentially causing adverse health effects [ 39 , 40 , 41 , 42 ].…”

Prevalence and Genetic Diversity of Clostridium perfringens Isolates in Hospitalized Diarrheal Patients from Central China

“…Infection and Drug Resistance 2021:14 https://doi.org/10.2147/IDR.S338593 DovePress 4789 found at higher rates in feces of autism spectrum disorder (ASD) children and infants aged <6 months. [24][25][26] Another study demonstrated that beta 2 toxin contributed to necrotizing soft tissue infections in hospitalized patients. 27 Further studies are required to investigate the pathogenic significance of beta 2 toxin produced by C. perfringens isolates in humans.…”

Hygiene Aspects of Premature Nutrition

“…The positive effect of breastmilk has been seen only for breast-fed infants and infants fed with extracted milk from their own mother. In pasteurised donor milk, the effects have not been observed [16,51]. An antibiotic treatment can also cause imbalances of the gut flora causing severe health problems caused by Cl.…”