ArticlePloS one2017
Epidemiology of Clostridium difficile in infants in Oxfordshire, UK: Risk factors for colonization and carriage, and genetic overlap with regional C. difficile infection strains.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers.
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Who cites it
49 citing papers in PubMed, 90 citations in OpenAlex.
- Safety and Efficacy of Fidaxomicin and Vancomycin in Children and Adolescents with Clostridioides (Clostridium) difficile Infection: A Phase 3, Multicenter, Randomized, Single-blind Clinical Trial (SUNSHINE).Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Trial
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- Evaluation of the Efficacy of UV-C Radiation in EliminatingMicroorganisms · 2025Article
- Clostridioides difficile concentration-dependant alterations in gut microbiota of asymptomatic infants.Gut pathogens · 2025Article
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- Molecular Epidemiology ofOpen forum infectious diseases · 2024Article
- Review
- Analysis of risk factors for community-acquiredTranslational pediatrics · 2023Article
- Clostridioides difficile infection in infants: a case report and literature review.Gut pathogens · 2023Article
- Article
- Article
- Prevalence and risk factors of toxigenicFrontiers in medicine · 2023Article
- Early Life Antimicrobial Exposure: Impact onAntibiotics (Basel, Switzerland) · 2022Article
- Clostridioides difficile colonization among very young children in resource-limited settings.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2022Article
- Faecal carriage ofEpidemiology and infection · 2022Article
- Molecular epidemiology ofFrontiers in public health · 2022Article
- Children gut microbiota exhibits a different composition and metabolic profile afterFrontiers in microbiology · 2022Article
- Gut Microbiota Diversity of Preterm Neonates Is Associated WithFrontiers in cellular and infection microbiology · 2022Article
- Evaluation of an immunochromatographic test for the detection of glutamate dehydrogenase for the diagnosis of Clostridioides (Clostridium) difficile infection in dogs.Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology] · 2021Article
Corrections and comments
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Authors and funding
23 authors at 5 institutions in 4 countries.
Funding
Abstract
backgroundApproximately 30-40% of children <1 year of age are Clostridium difficile colonized, and may represent a reservoir for adult C. difficile infections (CDI). Risk factors for colonization with toxigenic versus non-toxigenic C. difficile strains and longitudinal acquisition dynamics in infants remain incompletely characterized.
methodsPredominantly healthy infants (≤2 years) were recruited in Oxfordshire, UK, and provided ≥1 fecal samples. Independent risk factors for toxigenic/non-toxigenic C. difficile colonization and acquisition were identified using multivariable regression. Infant C. difficile isolates were whole-genome sequenced to assay genetic diversity and prevalence of toxin-associated genes, and compared with sequenced strains from Oxfordshire CDI cases.
results338/365 enrolled infants provided 1332 fecal samples, representing 158 C. difficile colonization or carriage episodes (107[68%] toxigenic). Initial colonization was associated with age, and reduced with breastfeeding but increased with pet dogs. Acquisition was associated with older age, Caesarean delivery, and diarrhea. Breastfeeding and pre-existing C. difficile colonization reduced acquisition risk. Overall 13% of CDI C. difficile strains were genetically related to infant strains. 29(18%) infant C. difficile sequences were consistent with recent direct/indirect transmission to/from Oxfordshire CDI cases (≤2 single nucleotide variants [SNVs]); 79(50%) shared a common origin with an Oxfordshire CDI case within the last ~5 years (0-10 SNVs). The hypervirulent, epidemic ST1/ribotype 027 remained notably absent in infants in this large study, as did other lineages such as STs 10/44 (ribotype 015); the most common strain in infants was ST2 (ribotype 020/014)(22%).
conclusionsIn predominantly healthy infants without significant healthcare exposure C. difficile colonization and acquisition reflect environmental exposures, with pet dogs identified as a novel risk factor. Genetic overlap between some infant strains and those isolated from CDI cases suggest common community reservoirs of these C. difficile lineages, contrasting with those lineages found only in CDI cases, and therefore more consistent with healthcare-associated spread.
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