Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

Abstract

IMPORTANCE Detection of Clostridioides difficile has frequently been described in asymptomatic infants and children, but accurate estimates across the age spectrum are unavailable. OBJECTIVE To assess the prevalence of C difficile detection among asymptomatic children across the age spectrum. DATA SOURCES This systematic review and meta-analysis included a search of the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Scopus, and Web of Science for articles published from January 1, 1990, to December 31, 2020. Search terms included Clostridium difficile, Peptoclostridium difficile, Clostridioides difficile, CDF OR CDI OR c diff OR c difficile, Clostridium infections OR cd positive diarrhea OR cd positive diarrhea OR Clostridium difficile OR Peptoclostridium difficile OR pseudomembranous colitis OR pseudomembranous enterocolitis, enterocolitis, and pseudomembranous. These were combined with the following terms: bacterial colonization and colonization OR colonized OR colonizing OR epidemiology OR prevalence OR seroprevalence. STUDY SELECTION Studies were screened independently by 2 authors. Studies were included if they reported testing for C difficile among asymptomatic children (ie, children without diarrhea) younger than 18 years.DATA EXTRACTION AND SYNTHESIS Data were extracted independently and in duplicate by 2 reviewers. Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were used. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESThe primary outcome was prevalence of C difficile detection among asymptomatic children. Secondary outcomes included prevalence of toxigenic vs nontoxigenic strains of C difficile and prevalence of C difficile detection stratified by geographic region, income status, testing method, and year of testing. RESULTS A total of 95 studies with 19 186 participants were included. Rates of detection of toxigenic or nontoxigenic C difficile were greatest among infants aged 6 to 12 months (41%; 95% CI, 32%-50%) and decreased to 12% (95% CI, 7%-18%) among children aged 5 to 18 years. The prevalence of toxigenic C difficile colonization was lower, peaking at 14% (95% CI, 8%-21%) among infants aged 6 to 12 months and decreasing to 6% (95% CI, 2%-11%) among children older than 5 years. Although prevalence differed by geographic region (ie, North and South America vs Europe: β, −0.151, P = .001; North and South America vs Western Pacific: β, 0.136, P = .007), there was no difference by testing method (ie, culture vs polymerase chain reaction: β, 0.069, P = .052; culture vs enzyme immunoassay: β, −0.178, P = .051), income class (low-middle income vs high income: β, −0.144, P = .23; upper-middle vs high income: β, −0.020,

Early Life Antimicrobial Exposure: Impact on Clostridioides difficile Colonization in Infants

“…Importantly, the cumulative effect of antimicrobial exposure on C. difficile colonization remained in vaginally-delivered infants, even after adjusting for covariates, showing that the vulnerability of full-term newborns to antibiotic exposure is not related to caesarean delivery. Consistent with what others have reported [ 15 ], we found that up to 31% of infants were colonized with C. difficile at a time when gut microbiota are being established. Antimicrobial exposure significantly increased C. difficile colonization at both 3–4 months of age and 12 months of age.…”

“…At the older infant age, the association with antimicrobials was strongest from perinatal (maternal IAP and newborn IV) antibiotic exposure (odds ratio (OR):1.33, 95% confidence interval (CI) 1.10–1.62; p = 0.003). Although C. difficile colonization of infants is asymptomatic [ 15 ], its presence in gut microbiota at this early age is associated with future asthma and allergic diseases [ 20 , 21 ]. Our study is the first to evaluate both the systemic antibiotic exposure and the environmental antimicrobial exposure of infants, with separate consideration of infants delivered vaginally and by caesarean section.…”

“…It is a major pathogen that is responsible for the clinical manifestations of antibiotic-induced diarrhea in adults and older children [ 14 ]. Although the colonization rate is high (over 40%) in infants below the age of 1 year, the biological relevance of C. difficile in this age group remains uncertain, as most colonized infants do not manifest clinical symptoms [ 15 ]. However, colonization in infancy may serve as a reservoir for adult C. difficile infections (CDI) or a marker for reduced colonization resistance and delayed gut microbiota maturation [ 16 , 17 , 18 ].…”

Specific gut microbiota alterations in essential tremor and its difference from Parkinson’s disease

“…The decrease of these beneficial genera may participate in the immune response of opportunistic pathogens and the modulation of intestinal permeability. Besides, Helicobacter 29 , Peptoclostridium 30 and Aeromonas 31 were considered multifactorial and could lead to the immune host response in certain virulent circumstances. Although we couldn't clarify the precise role of the altered gut microbiota in ET due to its limitation to species level interpretation, we still confirmed its specific taxa difference and this published literature of such microbial function could give hints for further research.…”

Enteric Pathogen Testing Importance for Children with Acute Gastroenteritis: a Modified Delphi Study

“…If used, multiplex panels should be coupled with established diagnostic stewardship strategies ( 36 ), including annotation of pathogens not likely to benefit from antimicrobial treatment (e.g., STEC [ 12 , 37 ] and Salmonella [ 11 ]). In addition, selective suppression of results likely to indicate colonization (e.g., C. difficile in children <2 years old [ 38 , 39 ] and EPEC in high-income settings [ 40 , 41 ]) can prevent unnecessary treatment of these conditions. Suppression is ideally done at the instrument level to avoid putting laboratory personnel in the position of having information that is not made available to the clinical team.…”