The prevalence and molecular epidemiology of Clostridioides difficile in hospital-based pediatric populations in China

Area of Science:

• Clinical Microbiology and Infectious Diseases
• Molecular Epidemiology
• Antimicrobial Resistance (AMR)

Background:

• Clostridioides difficile (C. difficile) is a significant cause of healthcare-associated infections.
• Understanding its prevalence and characteristics in pediatric populations is vital for infection control.
• The role of asymptomatic carriers in the epidemiology of C. difficile and AMR is not fully elucidated.

Purpose of the Study:

• To investigate the prevalence, molecular epidemiology, AMR, and genetic relatedness of C. difficile in Chinese children.
• To identify risk factors and transmission dynamics associated with C. difficile colonization and infection.
• To inform targeted antimicrobial stewardship and surveillance strategies.

Main Methods:

• A multicenter cross-sectional study involving 1,442 stool samples from pediatric populations.
• Isolation and identification of C. difficile, followed by multilocus sequence typing (MLST) and core genome phylogenetic analysis.
• Antimicrobial susceptibility testing and molecular analysis of resistance genes and mobile genetic elements.

Main Results:

• A C. difficile prevalence of 16.8% was found, with 13.0% asymptomatic carriage and 0.98% infection.
• ST3 was the predominant sequence type, and lineage VI was most common in infection cases.
• High clindamycin resistance (64.5%) and moxifloxacin resistance (10.7%) were observed, linked to specific genes and mutations.

Conclusions:

• Asymptomatic pediatric carriers serve as a significant reservoir for C. difficile, harboring resistant strains.
• Hospital-wide contact likely facilitates transmission among asymptomatic carriers, highlighting potential for dissemination.
• Enhanced surveillance and antimicrobial stewardship are essential in Chinese healthcare settings to control C. difficile and AMR.