Impact and Time Course of &lt;b&gt;&lt;i&gt;Clostridium difficile&lt;/i&gt;&lt;/b&gt; Colonization in Very Low Birth Weight Infants

Pichler, Karin; Bausenhardt, Benjamin; Huhulescu, Steliana; Lindtner, Claudia; Indra, Alexander; Allerberger, Franz; Berger, Angelika

doi:10.1159/000488025

Cited by 3 publications

(13 citation statements)

References 21 publications

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“…Age groups included neonates (n = 13); infants (n = 24); and children 2 years or younger (n = 12), 3 years or younger (n = 3), 5 years or younger (n = 2), 8 years or younger (n = 2), 10 years or younger (n = 1), and older than 10 years (n = 32) . Seventy-seven studies included healthy children; other populations were premature or low-birth-weight infants (n = 6), patients with oncologic or hematologic disease (n = 9), patients with a diagnosis of malnourishment (n = 1), and outpatients attending gastroenterology clinics without C difficile –associated clinical symptoms (n = 2) (eTable 2 in the Supplement).…”

Section: Resultsmentioning

confidence: 99%

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Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

et al. 2021

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IMPORTANCE Detection of Clostridioides difficile has frequently been described in asymptomatic infants and children, but accurate estimates across the age spectrum are unavailable. OBJECTIVE To assess the prevalence of C difficile detection among asymptomatic children across the age spectrum. DATA SOURCES This systematic review and meta-analysis included a search of the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Scopus, and Web of Science for articles published from January 1, 1990, to December 31, 2020. Search terms included Clostridium difficile, Peptoclostridium difficile, Clostridioides difficile, CDF OR CDI OR c diff OR c difficile, Clostridium infections OR cd positive diarrhea OR cd positive diarrhea OR Clostridium difficile OR Peptoclostridium difficile OR pseudomembranous colitis OR pseudomembranous enterocolitis, enterocolitis, and pseudomembranous. These were combined with the following terms: bacterial colonization and colonization OR colonized OR colonizing OR epidemiology OR prevalence OR seroprevalence. STUDY SELECTION Studies were screened independently by 2 authors. Studies were included if they reported testing for C difficile among asymptomatic children (ie, children without diarrhea) younger than 18 years.DATA EXTRACTION AND SYNTHESIS Data were extracted independently and in duplicate by 2 reviewers. Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were used. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESThe primary outcome was prevalence of C difficile detection among asymptomatic children. Secondary outcomes included prevalence of toxigenic vs nontoxigenic strains of C difficile and prevalence of C difficile detection stratified by geographic region, income status, testing method, and year of testing. RESULTS A total of 95 studies with 19 186 participants were included. Rates of detection of toxigenic or nontoxigenic C difficile were greatest among infants aged 6 to 12 months (41%; 95% CI, 32%-50%) and decreased to 12% (95% CI, 7%-18%) among children aged 5 to 18 years. The prevalence of toxigenic C difficile colonization was lower, peaking at 14% (95% CI, 8%-21%) among infants aged 6 to 12 months and decreasing to 6% (95% CI, 2%-11%) among children older than 5 years. Although prevalence differed by geographic region (ie, North and South America vs Europe: β, −0.151, P = .001; North and South America vs Western Pacific: β, 0.136, P = .007), there was no difference by testing method (ie, culture vs polymerase chain reaction: β, 0.069, P = .052; culture vs enzyme immunoassay: β, −0.178, P = .051), income class (low-middle income vs high income: β, −0.144, P = .23; upper-middle vs high income: β, −0.020,

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Section: Resultsmentioning

confidence: 99%

“…Fifteen studies had a high risk of bias because the samples were not representative of the target population (eg, special populations) (eTable 3 in the Supplement). Most studies had either low (n = 88) or unclear (n = 5) risk of bias with regard to participant recruitment.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

et al. 2021

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“…Notably, most strains isolated by culture were non-toxigenic (92.9%). The reported rates of C. difficile colonization in PN are highly variable and originate primarily from outdated, singlecenter, culture-based studies (Cardines et al, 1988;Chang et al, 2012;Pichler et al, 2018). The C. difficile colonization rates depend on the detection method used.…”

Section: Discussionmentioning

confidence: 99%

“…Asymptomatic Clostridioides difficile colonization with both toxigenic and non-toxigenic strains has been reported in 17–70% of healthy children less than three years of age ( Enoch et al., 2011 ; Jangi and Lamont, 2010 ; Rousseau et al., 2011 ; Stoesser et al., 2017 ). Among pediatric populations, few studies have targeted C. difficile colonization in preterm neonates (PN); moreover, these studies are either outdated or based on culturing approaches ( Cardines et al., 1988 ; el-Mohandes et al., 1993 ; Tina et al., 1994 ; Chang et al., 2012 ; Ferraris et al., 2012 ; Pichler et al., 2018 ). Depending on the study, the colonization rate in PN ranges from 0% ( Tina et al., 1994 ) to 63% ( Cardines et al., 1988 ) and increases during the first month of life.…”

Section: Introductionmentioning

confidence: 99%

“…These factors influence gut colonization dynamics; for instance, the colonization rate is correlated to the hospital stay length and the resulting spore exposition ( Bacon et al., 1988 ). Antibiotherapy is also associated with more frequent C. difficile colonization in PN ( Tina et al., 1994 ; Pichler et al., 2018 ). Moreover, gut immaturity disturbs the gut microbiota, i.e., reduced bacterial diversity and richness and a low proportion of genera associated with health benefits ( Lactobacillus , Bacteroides , Bifidobacteria ) ( Gewolb et al., 1999 ; Drell et al., 2014 ).…”

Section: Introductionmentioning

confidence: 99%

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Gut Microbiota Diversity of Preterm Neonates Is Associated With Clostridioides Difficile Colonization

Couturier

Lepage

Jolivet

et al. 2022

Front. Cell. Infect. Microbiol.

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In adults, Clostridioides difficile infections are associated with alterations of the intestinal bacterial populations. Although preterm neonates (PN) are frequently colonized by C. difficile, limited data are available regarding the relationship between C. difficile and the intestinal microbiota of this specific population. Therefore, we studied the intestinal microbiota of PN from two multicenter cohorts using high-throughput sequencing of the bacterial 16S rRNA gene. Our results showed that alpha diversity was significantly higher in children colonized by C. difficile than those without colonization. Beta diversity significantly differed between the groups. In multivariate analysis, C. difficile colonization was significantly associated with the absence of postnatal antibiotherapy and higher gestational age. Taxa belonging to the Lachnospiraceae, Enterobacteriaceae, Oscillospiraceae families and Veillonella sp. were positively associated with C. difficile colonization, whereas Bacteroidales and Bifidobacterium breve were negatively associated with C. difficile colonization. After adjustment for covariables, Clostridioides, Rothia, Bifidobacterium, Veillonella, Eisenbergiella genera and Enterobacterales were more abundant in the gut microbiota of colonized children. There was no significant association between C. difficile colonization and necrotizing enterocolitis in PN. Our results suggest that C. difficile colonization in PN is related to the establishment of physiological microbiota.

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Clostridioides difficile Infection in Children: Recent Updates on Epidemiology, Diagnosis, Therapy

Shirley,

Tornel,

Warren

et al. 2023

Pediatrics

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Clostridioides (formerly Clostridium) difficile is the most important infectious cause of antibiotic-associated diarrhea worldwide and a leading cause of healthcare-associated infection in the United States. The incidence of C. difficile infection (CDI) in children has increased, with 20 000 cases now reported annually, also posing indirect educational and economic consequences. In contrast to infection in adults, CDI in children is more commonly community-associated, accounting for three-quarters of all cases. A wide spectrum of disease severity ranging from asymptomatic carriage to severe diarrhea can occur, varying by age. Fulminant disease, although rare in children, is associated with high morbidity and even fatality. Diagnosis of CDI can be challenging as currently available tests detect either the presence of organism or disease-causing toxin but cannot distinguish colonization from infection. Since colonization can be high in specific pediatric groups, such as infants and young children, biomarkers to aid in accurate diagnosis are urgently needed. Similar to disease in adults, recurrence of CDI in children is common, affecting 20% to 30% of incident cases. Metronidazole has long been considered the mainstay therapy for CDI in children. However, new evidence supports the safety and efficacy of oral vancomycin and fidaxomicin as additional treatment options, whereas fecal microbiota transplantation is gaining popularity for recurrent infection. Recent advancements in our understanding of emerging epidemiologic trends and management of CDI unique to children are highlighted in this review. Despite encouraging therapeutic advancements, there remains a pressing need to optimize CDI therapy in children, particularly as it pertains to severe and recurrent disease.

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

Cited by 3 publications

References 21 publications

Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

Gut Microbiota Diversity of Preterm Neonates Is Associated With Clostridioides Difficile Colonization

Clostridioides difficile Infection in Children: Recent Updates on Epidemiology, Diagnosis, Therapy

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