As educators, we love—and are always humbled by—those moments when we get to say, “I don’t know.” For some of these questions, you may already know the answers.
For others, you may never have thought to ask the question. For all, questions, comments, concerns, and critiques are encouraged. Welcome to the Kids Korner.
Spring often means baseball, warmth…diarrhea, and fever. Let’s take a look at some fun topics on these last two.
Question. Are infants’ intestines commonly colonized with Clostridium difficile bacteria, and if so, how should this impact testing decisions?
An early article by Cooperstock et al prospectively evaluated 107 healthy asymptomatic infants up to a year of age from well-baby clinics.1 The infants’ ages ranged from 1 to 52 weeks and included a wide range of socioeconomic groups. Evaluating stool samples by ELISA for C. difficile antigens, the authors found that 40 percent (43/107) of infants were asymptomatically colonized with C. difficile. Additionally, there were no significant differences in colonization when these infants were stratified by age (in weeks) or sex. Other older studies have also demonstrated a high incidence of asymptomatic colonization by C. difficile in infants.2–4 The overall incidence of asymptomatic colonization in infants is reported to be as high as 60 percent to 70 percent.5 Interestingly, in the study by Cooperstock et al, the overall incidence of colonization of breastfed infants versus formula-fed infants was 23 percent versus 62 percent (P<0.001), respectively.1 This association has been identified in other studies as well.4,5
Recent studies continue to demonstrate asymptomatic colonization in infants and very young children. A recent 2012 cross-sectional study of two day cares by Rousseau et al demonstrated an asymptomatic C. difficile carriage incidence of 45 percent (38/85 total children).6 Every carrier, except one, was <24 months of age. None of the patients had diarrhea at the time of sampling. The incidence of asymptomatic carriage was approximately 6 percent (1/17) in children 24–36 months old, which is similar to reported adult asymptomatic carrier values of C. difficile.6
The overall incidence of asymptomatic colonization in infants is reported to be as high as 60 percent to 70 percent.
A separate cross-sectional study in 1982 by Stark et al demonstrated an asymptomatic carrier incidence of 3 percent (1/37) in children ≥2 years.2 In that same study, the asymptomatic adult carrier incidence was 3.6 percent. A different study in 1989 by Tullus et al prospectively followed 343 asymptomatic healthy clinic infants from birth to 18 months, finding that carriage at 18 months of age (3 percent) was similar to adult incidences.4