The role of Clostridium difficile in the paediatric and neonatal gut - a narrative review.
Clostridium difficile is an important nosocomial pathogen in adults. Its significance in children is less well defined, but cases of C. difficile infection (CDI) appear to be increasingly prevalent in paediatric patients. This review aims to summarize reported Clostridium difficile carriage rates across children of different age groups, appraise the relationship between CDI and factors such as method of delivery, type of infant feed, antibiotic use, and co-morbidities, and review factors affecting the gut microbiome in children and the host immune response to C. difficile. Searches of PubMed and Google Scholar using the terms 'Clostridium difficile neonates' and 'Clostridium difficile children' were completed, and reference lists of retrieved publications screened for further papers. In total, 88 papers containing relevant data were included. There was large inter-study variation in reported C. difficile carriage rates. There was an association between CDI and recent antibiotic use, and co-morbidities such as immunosuppression and inflammatory bowel disease. C. difficile was also found in stools of children with diarrhoea attributed to other pathogens (e.g. rotavirus). The role of C. difficile in the paediatric gut remains unclear; is it an innocent bystander in diarrhoeal disease caused by other organisms, or a pathogen causing subclinical to severe symptoms? Further investigation of the development of serological and local host response to C. difficile carriage may shed new light on disease mechanisms. Work is underway on defining a framework for diagnosis and management of paediatric CDI.
University of Liverpool Institute of Translational Medicine, Wolfson Centre, Block A: Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK. emilylees@doctors.org.uk.
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Lees
University of Liverpool Institute of Translational Medicine, Wolfson Centre, Block A: Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
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Miyajima
University of Liverpool Institute of Translational Medicine, Wolfson Centre, Block A: Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
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Pirmohamed
Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, Ronald Ross Building, West Derby Street, Liverpool, L69 7BE, UK.
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Carrol
D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers; D002353:Carrier State; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000502:physiology*; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission; D036861:Delivery, Obstetric; D004781:Environmental Exposure; D041981:Gastrointestinal Tract / Q000382:microbiology*; D054884:Host-Pathogen Interactions; D006801:Humans; D007223:Infant; D007225:Infant Food; D007231:Infant, Newborn; D011159:Population Surveillance; D015995:Prevalence; D012008:Recurrence; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D015415:Biomarkers