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Intestinal colonization with Clostridium difficile in infants up to 18 months of age
K Tullus1, B Aronsson, S Marcus
1Department of Pediatrics, Danderyd Hospital, Sweden.
Insights
Infant gut colonization with Clostridium difficile is common early in life, decreasing by 18 months. Breastfeeding reduces colonization risk, which is linked to later diarrheal disease.
Area of Science:
- Microbiology
- Pediatrics
- Gastroenterology
Background:
- Clostridium difficile colonization is prevalent in infants.
- Understanding infant Clostridium difficile colonization dynamics is crucial for pediatric health.
Purpose of the Study:
- To investigate the incidence and patterns of Clostridium difficile colonization in infants.
- To explore the association between Clostridium difficile colonization, feeding method, and diarrheal disease.
- To assess the impact of antibiotic therapy on colonization.
Main Methods:
- Longitudinal study of 343 infants over 18 months.
- Rectal swabs collected at multiple time points: 6 days, 6 weeks, 6 months, 11 months, and 18 months.
- Analysis of colonization rates, toxin production, feeding methods, and diarrheal disease incidence.
Main Results:
- Approximately 25% of infants were colonized by 6 months, decreasing to 3% by 18 months.
- Toxin-producing strains were infrequent in younger infants but common by 6 months.
- Breast-fed infants showed significantly lower colonization rates than bottle-fed infants.
- Colonization at 6 months was associated with increased diarrheal disease, especially with persistent colonization.
Conclusions:
- Infant Clostridium difficile colonization is common but typically transient.
- Breastfeeding offers protection against colonization.
- Early Clostridium difficile colonization may predispose infants to diarrheal illness.
- Antibiotic therapy did not influence colonization rates in this cohort.
Abstract:
The faecal colonization with Clostridium difficile was investigated among 343 infants during their first 18 months of life. Rectal swabs were taken at the ages of 6 days, 6 weeks, 6 months, 11 months and 18 months. About 25% of the children were colonized with Clostridium difficile between 6 days and 6 months of age. The colonization rate decreased to 3% at 18 months of age. The rate of strains producing cytotoxin was low in infants less than 6 months of age, but at that age about half of the strains isolated were toxin-producing. Breast-fed children were significantly less often colonized with Clostridium difficile than were bottle-fed infants, both at 6 weeks of age (21% versus 47%, p less than 0.05) and at 6 months of age (19% versus 39%, p less than 0.001). Colonization with Clostridium difficile at 6 months of age was associated with a greater frequency of diarrhoeal disease between 6 and 11 months of age (27% versus 16%, p less than 0.05). This association was even more pronounced when the bacteria persisted at 11 months of age (54%, p less than 0.01). Antibiotic therapy could not be demonstrated to influence colonization with Clostridium difficile at any age.