Prevalence and diversity of Clostridium difficile strains in infants

Rousseau, Clotilde; Lemée, Ludovic; Monnier, Alban Le; Poîlane, I.; Pons, Jean-Louis; Collignon, Anne

doi:10.1099/jmm.0.029736-0

Cited by 85 publications

(70 citation statements)

References 32 publications

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“…Among newborns and healthy infants, carriage rates may be as high as 84.4 % up to age 2 years ( 199,201,202 ). Some infants may have non-toxigenic strains.…”

Section: Appendixmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,467

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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“…Among newborns and healthy infants, carriage rates may be as high as 84.4 % up to age 2 years ( 199,201,202 ). Some infants may have non-toxigenic strains.…”

Section: Appendixmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,467

1,408

View full text Add to dashboard Cite

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“…Meanwhile, the proportion of toxin positivity as assessed by PCR assays using total bacterial genomic DNA as a template was 25-37.5%, which corresponded to the lowest value reported in previous studies (33-100%) using both culture and direct fecal cytotoxin detection in cultured cells [10,19,26]. It has been reported that many asymptomatic infants under 2 years of age are frequently colonized with both nontoxigenic and toxigenic strains [10,38].…”

Section: Discussionmentioning

confidence: 75%

“…It has been reported that many asymptomatic infants under 2 years of age are frequently colonized with both nontoxigenic and toxigenic strains [10,38]. The reported proportion of toxigenic strains is 21-37.5%.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, recent case reports suggested that C. difficile could be transmitted from infants with asymptomatic colonization to their nursing mothers, who subsequently develop recurrent pseudomembranous colitis [8,9]. C. difficile strains identical to those in adults were identified in asymptomatic infants even in the community [10]. Therefore, asymptomatic C. difficile infection in preterm infants may be medically important in the aspect of the potential of infected neonates to serve as reservoirs for C. difficile transmission in older children and adults, leading to symptomatic infection.…”

Section: Introductionmentioning

confidence: 99%

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Monitoring ofClostridium difficileColonization in Preterm Infants in Neonatal Intensive Care Units

Chang

Shim

et al. 2012

Pediatr Gastroenterol Hepatol Nutr

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“…In premature neonates, if clostridia are the most common anaerobes found in fecal samples during the first 2 months of life (3)(4)(5)(6)(7), then asymptomatic intestinal carriage of toxigenic or nontoxigenic strains is common and not systematically associated with infections, particularly for C. difficile (8,9). However, various clostridial species have been recovered in neonatal bacteremia (10), and several reports have suggested the role of clostridia in the pathogenesis of necrotizing enterocolitis (NEC) (11)(12)(13)(14), a devastating neonatal gastrointestinal disease with high morbidity and mortality rates (15).…”

mentioning

confidence: 99%

16S rRNA Gene Sequencing, Multilocus Sequence Analysis, and Mass Spectrometry Identification of the Proposed New Species “Clostridium neonatale”

et al. 2014

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In 2002, an outbreak of necrotizing enterocolitis in a Canadian neonatal intensive care unit was associated with a proposed novel species of Clostridium, "Clostridium neonatale." To date, there are no data about the isolation, identification, or clinical significance of this species. Additionally, C. neonatale has not been formally classified as a new species, rendering its identification challenging. Indeed, the C. neonatale 16S rRNA gene sequence shows high similarity to another Clostridium species involved in neonatal necrotizing enterocolitis, Clostridium butyricum. By performing a polyphasic study combining phylogenetic analysis (16S rRNA gene sequencing and multilocus sequence analysis) and phenotypic characterization with mass spectrometry, we demonstrated that C. neonatale is a new species within the Clostridium genus sensu stricto, for which we propose the name Clostridium neonatale sp. nov. Now that the status of C. neonatale has been clarified, matrix-assisted laser desorption ionizationtime of flight mass spectrometry (MALDI-TOF MS) can be used for better differential identification of C. neonatale and C. butyricum clinical isolates. This is necessary to precisely define the role and clinical significance of C. neonatale, a species that may have been misidentified and underrepresented during previous neonatal necrotizing enterocolitis studies.

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Prevalence and diversity of Clostridium difficile strains in infants

Cited by 85 publications

References 32 publications

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Monitoring ofClostridium difficileColonization in Preterm Infants in Neonatal Intensive Care Units

16S rRNA Gene Sequencing, Multilocus Sequence Analysis, and Mass Spectrometry Identification of the Proposed New Species “Clostridium neonatale”

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