Is Clostridium difficile a pathogen in the newborn intensive care unit? A prospective evaluation.
OBJECTIVE
The purpose of this study was to investigate (1) the presence of Clostridium difficile toxin in patients in the newborn intensive care unit and (2) the association of C. difficile toxin with gastrointestinal tract symptoms in this population.


METHODS
A prospective, masked study was done in which twice-weekly stool specimens of subjects hospitalized in a newborn intensive care unit during a 4-month period were analyzed for C. difficile toxin A by enzyme immunoassay. Daily data collection included infant clinical status, stool frequency and character, presence of gastrointestinal tract symptoms, and actions taken for gastrointestinal tract symptoms. Infants hospitalized 5 or more days who had at least two stool assays comprised the study population. For data analysis, an infant with C. difficile toxin-positive status was defined as an infant with two or more toxin-positive stools.


RESULTS
Of 87 infants who met study criteria, 42 (48%) had toxin-negative and 45 (52%) toxin-positive results on at least one specimen. Of the infants with toxin-positive findings, 27 (31%) had two or more positive stool assays and comprised the comparison group. The infants with toxin-positive results were smaller, less mature, and had a longer hospital stay than infants with toxin-negative results (p < 0.001). Infants with toxin-positive findings had more days per infant with frequent (> 6) stools and abnormal stools (p < 0.001). The total number of symptom days was 8.2 +/- 5.7 in infants in the toxin-positive group versus 2.2 +/- 2.2 in those in the toxin-negative group (p < 0.001). The mean number of times stools were sent for evaluation and culture was greater in infants with toxin-positive findings (p < or = 0.012) whereas there was no difference in the number of times oral feedings were withheld from infants or infants had abdominal films obtained (p > or = 0.18).


CONCLUSIONS
Infants hospitalized in our newborn intensive care unit frequently had stools positive for C. difficile toxin A. When compared with infants with toxin-negative findings, infants with colonization had an increased number of days with gastrointestinal tract symptoms.
Enad
D
D
Division of Neonatology, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
Meislich
D
D
Brodsky
N L
NL
Hurt
H
H
D001427:Bacterial Toxins; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000453:epidemiology*; D004768:Enterotoxins / Q000032:analysis*; D005243:Feces / Q000382:microbiology; D006801:Humans; D007124:Immunoenzyme Techniques; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D011446:Prospective Studies; D013997:Time Factors
D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile