Reviewed by Cindy Noyes, MD, University of Vermont Medical Center
Bottom line: Given high frequency of colonization and now confirmed transmission to caregivers, infants could be one reservoir for C. difficile in the community.
Families attending a pediatric practice in Cleveland were recruited at their 4 month well child visit to explore C. difficile epidemiology in infants and assess for transmission to caregivers. Infants and mothers were required participants, fathers were encouraged but not mandatory. Infant monitoring consisted of submission of 1 soiled diaper mailed every two weeks until the child reached 8-9 months of age while mothers and fathers were asked to mail rectal specimens collected using commercial diaper wipes sent at the same frequency. Samples were inoculated onto C. difficile media and enriched broth. Molecular typing was performed (PCR typing and WGS with multi-locus sequence typing) and ELISA used to test for toxin production. Isolates were considered “shared” if isolated from >1 family member; “unique” if only from a single member of the family group. Transient colonization (one time detection) vs persistent (more than 1 time detection) were described.
Thirty families enrolled between Sept 2021 to Jan 2023. Both toxigenic and non-toxigenic C difficile were isolated in at least one member in 28 of 30 families. Strains were shared in 17 of 28 families and 90% of shared strains were toxigenic. The infant was usually the family member in whom the organism was first detected. Twenty-five families harbored 49 isolates that were unique (not found in other family members)—27 in infants, 22 in adults; and 43% of these were toxigenic. Organisms regularly appeared and disappeared. Many families had multiple strains isolated concomitantly. Prevalence among infants ranged 50-74% with high frequency of asymptomatic excretion in babies peaking around 6 months. Prevalence in mothers was 20-40%; and in fathers 20-37.5%–all higher than the reported prevalence reported in healthy adults that range 2-8%. None of the study participants were diagnosed with C. difficile infection. Thus, with high frequency of colonization and transmission, could infants be a community reservoir for C difficile?
Reference:
Marlow C, et al. Molecular epidemiology of Clostridioides difficile colonization in families with infants. OFID. 2024; DOI: https://10.1093/ofid/ofae299.