Epidemiology of Clostridium difficile in Infants

Larson, H Elliott; Barclay, Fiona; Honour, Pauline; Hill, I. D.

doi:10.1093/infdis/146.6.727

Cited by 199 publications

(97 citation statements)

References 21 publications

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“…We did not detect C. difficile in any meconium specimens (Fig. 1), and it was detected in only 1 of 109 maternal stool specimens collected before delivery (data not shown), in agreement with data from previous studies (28)(29)(30)(31)(32). Therefore, it is quite unlikely that C. difficile is transmitted from the mother to the infant gut.…”

Section: Table 4 Isolation and Characterization Of Toxigenic Clostridsupporting

confidence: 92%

Longitudinal Investigation of Carriage Rates, Counts, and Genotypes of Toxigenic Clostridium difficile in Early Infancy

Kubota

Makino

Gawad³

et al. 2016

Appl Environ Microbiol

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Asymptomatic infant carriers of toxigenic Clostridium difficile are suggested to play a role in the transmission of C. difficile infection (CDI) in adults. However, the mode of C. difficile carriage in infants remains to be fully elucidated. We investigated longitudinal changes in carriage rates, counts, and strain types of toxigenic C. difficile in infants. Stools collected from 111 healthy infants in Belgium periodically from birth until the age of 6 months were examined by quantitative PCR targeting 16S rRNA and toxin genes. Toxigenic C. difficile was detected in 18 of 111 infants (16%) in the period up to the age of 6 months. The carriage rate of toxigenic C. difficile remained below 5% until the age of 3 months. The carriage rate increased to 13% 1 week after weaning (average age, 143 days) and reached 16% at the age of 6 months. Counts of toxigenic C. difficile bacteria ranged from 10 4 to 10 8 cells/g of stool. Notably, two infants retained >10 8 cells/g of stool for at least several weeks. Average counts in the 18 infants hovered around 10 7 cells/g of stool from the age of 3 days until the age of 6 months, showing no age-related trend. Genotyping of toxigenic C. difficile isolates from the 18 infants revealed that 11 infants each retained a particular monophyletic strain for at least a month. The genotype most frequently identified was the same as that frequently identified in symptomatic adult CDI patients. Thus, toxigenic C. difficile strains-potential causes of CDI in adults-colonized the infants' intestines. IMPORTANCEOur study provides longitudinal data on counts and strain types of toxigenic C. difficile in infants. We found that considerable numbers of toxigenic C. difficile bacteria colonized the infants' intestines. The results of strain typing suggest that toxigenic C. difficile carried by healthy infants could be potentially pathogenic to adults. These results and findings are informative not only for ecological studies but also for efforts to prevent or control the spread of CDI in adults. Toxigenic Clostridium difficile is the main cause of health careassociated gastrointestinal infections. In general, C. difficile is not a normal inhabitant of the adult gastrointestinal tract, because its colonization is considered to be prevented by the presence of commensal microbiota (1-3). Colonization of the intestines by toxigenic C. difficile is the first crucial step in the development of C. difficile infection (CDI). Accumulating evidence suggests that disruption of the microbiota and frequent exposure to toxigenic C. difficile could increase the risk of CDI (4-6). Whereas asymptomatic carriage of toxigenic C. difficile is rare in adults, occurring in Ͻ5% of adults (7,8), it is very common in infants (9, 10), probably due to the immaturity of the microbiota composition. Regardless of the high prevalence, a great majority of infants rarely show CDI-related abdominal symptoms. The presumed reason for this is that infants are not susceptible to C. difficile toxins owing to the poor developmen...

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Section: Table 4 Isolation and Characterization Of Toxigenic Clostridsupporting

confidence: 92%

Longitudinal Investigation of Carriage Rates, Counts, and Genotypes of Toxigenic Clostridium difficile in Early Infancy

Kubota

Makino

Gawad³

et al. 2016

Appl Environ Microbiol

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“…High rates of C. difficile colonization have been well documented in infants less than 1 year of age (242)(243)(244)(245). Infants who are breastfed appear to have lower carriage rates (14%) than formula-fed infants (30%) (246).…”

Section: Special Patient Populations Childrenmentioning

confidence: 99%

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

2013

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SUMMARY Clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile . This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI). In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of C. difficile in clinical specimens does not always equate with disease, the diagnosis of C. difficile infection continues to be a challenge for both laboratories and clinicians.

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“…5 Vaginal delivery, premature rupture of membranes, and previous administration of antimicrobial agents have little effect on carriage rates, but exposure to environments where C difficile is present (eg, ICUs) is important. [6][7][8] The organism has been recovered from the hands of hospital personnel, baby baths, oximeters, electronic thermometers, and hospital floors. Breastfed infants have lower carriage rates than do formulafed infants (14% vs 30%, respectively).…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile Infection in Infants and Children

Schutze¹,

Willoughby²

2013

Pediatrics

226

100

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Infections caused by Clostridium difficile in hospitalized children are increasing. The recent publication of clinical practice guidelines for C difficile infection in adults did not address issues that are specific to children. The purpose of this policy statement is to provide the pediatrician with updated information and recommendations about C difficile infections affecting pediatric patients. Pediatrics

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Epidemiology of Clostridium difficile in Infants

Cited by 199 publications

References 21 publications

Longitudinal Investigation of Carriage Rates, Counts, and Genotypes of Toxigenic Clostridium difficile in Early Infancy

Longitudinal Investigation of Carriage Rates, Counts, and Genotypes of Toxigenic Clostridium difficile in Early Infancy

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

Clostridium difficile Infection in Infants and Children

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