Epidemiological Features of Clostridium difficile Colonizing the Intestine of Jordanian Infants.

Eman N Abu-Khader,Asem A Shehabi,Eman F Badran

doi:10.1155/2017/2692360

Eman N Abu-Khader, Asem A Shehabi + Show 1 more

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https://doi.org/10.1155/2017/2692360

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Abstract

Clostridium difficile is commonly found in the intestine of infants without causing any disease. This study investigated the most important epidemiological features of C. difficile strains colonizing intestine of Jordanian infants. A total of 287 fecal samples were collected from infants admitted to the Jordan University Hospital (JUH) over the period of 2015. Samples were cultured for C. difficile and their growth was identified using microbiological culture and PCR. The overall C. difficile colonization rate among hospitalized and nonhospitalized infants was 37/287 (12.9%). Neonates were less colonized than other infants (8.7% verses 19.5%). Colonization of the infants with C. difficile toxigenic strains (TcdA and TcdB) was observed in 54% of the isolates, whereas those colonized with nontoxigenic strains were 46% and only one isolate was positive for binary toxin. Breast feeding of infants is a significant factor associated with decreased colonization with C. difficile. All C. difficile strains were susceptible to vancomycin and metronidazole, while high resistance rate to ciprofloxacin (78.4%) and less resistance rate to erythromycin (29.7%) were detected among the isolates. The results showed that 40.5% of the isolates carried mutated gyrA and gyrB genes which have cross-resistance to ciprofloxacin and moxifloxacin. This study represents useful epidemiological features about C. difficile colonizing intestine of infants living in a developing country.

Highlights

Clostridium difficile is a major cause of nosocomial antibioticassociated diarrhea due to the production of toxins A and B
This study demonstrates relatively low colonization rate of C. difficile (12.9%) in stools of hospitalized and nonhospitalized infants aged ≤1 year
Toxigenic C. difficile accounted for 54.1% of the isolates (Tables 1 and 2)

Summary

Introduction

Clostridium difficile is a major cause of nosocomial antibioticassociated diarrhea due to the production of toxins A and B. CDI can be associated with significant morbidity, mortality, and healthcare costs in hospitalized patients [1, 2]. Increased incidence of CDI is coupled with more serious clinical presentation; especially mortality among patients ranges from 24 to 50% [3,4,5]. Several hypotheses have been reported to explain asymptomatic state of C. difficile in newborns. These include the competitive intestinal colonization by nontoxigenic strains, the immaturity of the immune system, possible absence of toxin receptors in the intestinal tract, modulation of toxin production by the infant microbiota, and toxin neutralization by maternal antibodies [6, 9]

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