536. Clostridium difficile Colonization in the First Year of Life.
Session: Poster Abstract Session: Healthcare Epidemiology: Updates in C. difficile
Thursday, October 4, 2018
Room: S Poster Hall
  • IDSA Poster - First year of life.pdf (442.8 kB)
  • Background: Recent years have witnessed an explosive increase in community-associated Clostridium difficile infection (CA-CDI) in adults. Contact with infants, a population known to be asymptomatically colonized by C. difficile (CD), has been identified as a risk factor for CA-CDI, rendering it vital to explore the epidemiology and determinants of acquisition in babies.

    Methods: In this prospective cohort study, healthy infants attending a demographically diverse suburban pediatric practice were enrolled at birth and followed through their 2-month, 6-month, and 12-month well child visit. At each visit, stool samples were collected, and questionnaires including interim exposure to potential risk factors for CD acquisition were administered. Stool was inoculated on pre-reduced CCFA agar with a graduated loop. Among CD isolates, toxin genes were identified by PCR.

    Results: Fifty infants were recruited; 90% of samples and questionnaires were completed. The average gestational age was 39 weeks and 46% were male. 28 (56%) infants had at least 1 sample positive for CD during the study: cross sectional incidence was 0/50 at birth; 9/47 (19%) at 2 months; 22/43 (51%) at 6 months; 6/37 (16%) at 1 year. Of those with positive stool cultures, 3 (11%) tested positive at multiple visits. 30/37 (81%) isolates were PCR-positive for CD toxin. 5 stool samples harbored > 4.5 log10 cfu of toxigenic CD/gm of stool. Proportions of CD+ vs CD- subjects, respectively, with interim exposure to selected CD risk factors at each visit were as follows: infant healthcare visit 45% vs 42%; household member healthcare visit 17% vs 23%; household member with diarrhea 14% vs 29%; antibiotic exposure 5 % vs 4%; antacid exposure 7% vs 3%, all P > .05. Regarding risks for acquisition of enteric pathogens in general: breastmilk-including nutrition 57% vs 73% (P < .05 only at 2-month visit); 48% CD+ infants had interim daycare attendance vs 25% CD- (but P > .05 at each visit).

    Conclusion: Asymptomatic carriage of toxigenic CD occurred in over half of healthy infants during the first year of life, and several had a high organism burden that could increase the risk for transmission. While daycare attendance was more common among colonized infants, the majority of infants who were CD+ had no daycare exposure.

    Jason A. Clayton, MD, PhD1, Jennifer Cadnum, B.S.2, Shelly Senders, MD3, Curtis J. Donskey, MD4 and Philip Toltzis, MD1, (1)Pediatric Critical Care Medicine, UH Rainbow Babies and Children's Hospital, Cleveland, OH, (2)Research Service, Cleveland VA Medical Center, Cleveland, OH, (3)Senders Pediatrics, South Euclid, OH, (4)Infectious Diseases, Case Western Reserve University, Cleveland, OH


    J. A. Clayton, None

    J. Cadnum, None

    S. Senders, None

    C. J. Donskey, None

    P. Toltzis, None

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