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Colonization of the large bowel by Clostridium difficile in healthy infants: quantitative study
Insights
Clostridium difficile colonization is common in healthy infants, particularly formula-fed ones, with levels similar to those causing disease in adults. Carriage rates decrease significantly after the first year of life.
Area of Science:
- Microbiology
- Gastroenterology
- Pediatrics
Background:
- Clostridium difficile is a bacterium known to cause gastrointestinal illness.
- Infant gut microbiota development is complex and influenced by feeding type.
- The prevalence and significance of C. difficile colonization in healthy infants are not fully understood.
Purpose of the Study:
- To investigate the colonization patterns of Clostridium difficile in healthy infants.
- To compare C. difficile colonization between breast-fed and formula-fed infants.
- To determine the age-related changes in C. difficile carriage rates.
Main Methods:
- Fecal samples were collected from infants throughout their first year of life.
- Quantification of C. difficile levels in fecal samples.
- Examination of additional fecal samples from children up to 4 years old.
- In vitro testing of C. difficile isolates for cytotoxin production.
Main Results:
- Colonization by C. difficile was observed in both breast-fed and formula-fed infants.
- Formula-fed infants showed higher levels of C. difficile colonization compared to breast-fed infants.
- C. difficile carriage rates decreased significantly after one year of age.
- A proportion of infant C. difficile isolates produced cytotoxin in vitro.
Conclusions:
- Healthy infants can be colonized by C. difficile, with varying levels and durations.
- Feeding method appears to influence C. difficile colonization levels in infants.
- Infant gut C. difficile carriage is transient and declines with age, though remains higher than in adults for a period.
Abstract:
Colonization of the large bowel of healthy infants by Clostridium difficile was studied. Feces were collected from five breast-fed aand five formula-fed infants throughout the first year of life, and levels of C. difficile were quantitated. Three breast-fed and five formula-fed infants were colonized for periods of between 8 and 42 weeks, and another infant harbored the organism only during week 1. Colonization of breast-fed infants commenced before or during weaning, with levels reaching 10(3) to 10(5) organisms per g of wet feces. Colonization of formula-fed infants commenced before solid foods were given, with levels of 10(3) to 10(7) organisms per g of wet feces. Isolates from eight of the babies were shown to produce cytotoxin in vitro. Single fecal specimens from 60 more children aged up to 4 years were also examined, and it was found that the carriage rate of C. difficile fell sharply after 1 year of age, although in the second year it was still higher than in adults. These findings are discussed in relation to the microbial ecology of the large bowel and the paradox that levels of C. difficile in the large bowel of healthy infants are similar to those causing pseudomembranous colitis in patients.