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A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
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Clostridium difficile Whole Genome Sequencing Reveals Limited Transmission Among Symptomatic Children: A

Larry K Kociolek1,2, Dale N Gerding3,4, Robyn O Espinosa2

  • 1Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|January 26, 2018
PubMed

Insights

Pediatric Clostridium difficile infections (CDIs) are rising, but transmission is rare. Whole genome sequencing revealed diverse strains, with few cases linked to healthcare or community spread, suggesting limited Clostridium difficile transmission among children.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Genomics

Background:

  • Pediatric Clostridium difficile infections (CDIs) are increasing globally.
  • Understanding transmission patterns of C. difficile in children is crucial but limited.

Purpose of the Study:

  • To investigate C. difficile transmission dynamics in pediatric patients using whole genome sequencing (WGS).
  • To identify the frequency and sources of C. difficile transmission among children with CDI.

Main Methods:

  • Whole genome sequencing (WGS) of C. difficile isolates from children diagnosed with CDI.
  • Comparison of genome sequences to identify isogenic strains (≤2-3 core genome single nucleotide variants).
  • Investigation of healthcare exposures for patients with isogenic isolates.

Main Results:

  • 104 genetically distinct C. difficile isolates were identified from 131 CDIs in 107 children.
  • Only 11.9% of incident CDIs occurring ≥8 weeks after study initiation were linked to transmission events.
  • Transmission events were infrequent across all CDI classes (hospital-onset healthcare facility-associated, community-associated, recurrent).
  • Shared healthcare exposures were identified in only 7 of 10 putative transmission events.
  • No evidence of community transmission was found based on postal code data.

Conclusions:

  • Whole genome sequencing revealed high diversity of C. difficile strains in pediatric CDI cases.
  • C. difficile transmission among symptomatic children is uncommon.
  • Identified transmission events often lacked clear links to shared healthcare exposures, indicating challenges in pinpointing sources.
Abstract

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