Clostridium difficileIsolation in Neonates in a Special Care Unit

Abstract

The stools of 78% of 45 infants in a Special Care Baby Unit yielded Clostridium difficile on culture, and in 67% of these it was possible to detect C. difficile toxin by means of a tissue culture technique. The stools of six of the seven infants with necrotizing enterocolitis were positive for C. difficile, but neither of the two most severely affected contained C. difficile toxin. The incidence of C. difficile isolation was similar in infants treated by exchange transfusion, those treated with antibiotics, those of low birth weight, and those with respiratory distress. The serum of only 2 of 28 infants and 1 of 20 mothers contained a neutralizing factor to C. difficile toxin. The present study does not support a role for C. difficile in neonatal disorders and in particular necrotizing enterocolitis. The reason for the apparent tolerance of the neonatal bowel to C. difficile toxin remains to be explained.

Impact and Time Course of <b><i>Clostridium difficile</i></b> Colonization in Very Low Birth Weight Infants

“…However, these findings were not significant in our study. Also, similarly to other studies [6, 7, 14, 21], in-hospital C. difficile colonization was not associated with the development of NEC in our study. This is an interesting finding as a recent in vivo study in mice described that neonatal acquisition of Clostridium spp.…”

“…As standards of NICU care have significantly developed since then, colonization rates detected in our study might not be comparable to these studies. Indeed, a more recent study by Rousseau et al [15] already reported a C. difficile colonization rate in term neonates of 33%, which is in agreement with our study and significantly lower than colonization rates reported before [14]. However, besides this study and ours, no recent data on colonization rates in very preterm babies exist.…”

“…In term neonates, community-acquired colonization rates were reported even up to 78% [14]. All these data are based on studies performed in the 80s and early 90s.…”

Focal Bacterial Infections

“…* Several reports provided evidence that C. perfringens [297,[361][362][363][364], Clostridium difficile [333,365], or Clostridium butyricum, acting alone [366,367] or synergistically with Klebsiella [368], was able to evoke NEC. Subsequent studies indicated, however, that these species were often acquired from the nursery environment [369,370] and could frequently be recovered from healthy neonates [359,[370][371][372][373][374][375][376]. Clostridial cytotoxin, which had been recovered from the stool of infants involved in an outbreak of NEC [333,365], has also been found in the stool of 90% of normal infants [333,364,369,[375][376][377].…”

Clostridium difficile infection in the pediatric surgery population

“…The morbidity and risk factors for disease are not well defined. Infants younger than 1 year are commonly colonized with C difficile with colony counts equal to adults with CDAD, but do not manifest diarrhea or features of toxic enterocolitis [17][18][19][20][21]. Neonates are generally resistant to the effects of C difficile toxins.…”