Clostridioides difficile colonization among very young children in resource-limited settings.
Clostridioides difficile colonization among very young children in resource-limited settings.
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在资源有限的环境中，艰难梭菌在幼童中的定植。
DOI：
10.1016/j.cmi.2022.01.022
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发表时间：
2022-07
影响因子：
14.2
通讯作者：
Warren, Cirle A.
中科院分区：
文献类型：
--
作者：
Brennhofer, Stephanie A.;McQuade, Elizabeth T. Rogawski;Liu, Jie;Guerrant, Richard L.;Platts-Mills, James A.;Warren, Cirle A.
描述八个资源匮乏地区幼儿中艰难梭菌 (C. difficile) 定植的流行病学和危险因素。在一项多地点出生队列研究中，我们使用定量 PCR (qPCR) 对 1715 名出生至两岁儿童的 41 354 份每月非腹泻和腹泻粪便中的艰难梭菌毒素基因（TcdA 和 TcdB）进行了检测。我们估计了艰难梭菌定植的流行率、累积发病率和季节性，并研究了艰难梭菌检测与感染危险因素、肠病标志物和生长的关联。与非腹泻粪便（6.1%；n = 2106/34 623）相比，腹泻粪便中艰难梭菌检出率较低（2.2%；n = 151/6731）。到 24 个月大时，艰难梭菌的累积发病率因地点而异，17.9%（n = 44；巴基斯坦）至 76.3%（n = 148；秘鲁）的儿童至少有一次大便呈阳性。只有孟加拉国和巴基斯坦的艰难梭菌检测存在季节性差异。女性（调整后风险比 (aRR)：1.18；95% CI：1.02–1.35）、过去 15 天内使用头孢菌素（aRR：1.73；95% CI：1.39–2.16）和处理过的水（aRR：1.24；95% CI：1.02–1.50）是C. 阳性困难。艰难梭菌的存在与粪便中髓过氧化物酶、新蝶呤和 α-1-抗胰蛋白酶的升高显着相关，但未发现艰难梭菌与 24 月龄儿童生长之间存在关联。在资源匮乏的地区，0-2 岁儿童的艰难梭菌定植情况各不相同。与艰难梭菌检测相关的肠道炎症和屏障破坏标记物显着升高表明定植的亚临床影响。
To describe the epidemiology and risk factors for Clostridioides difficile (C. difficile) colonization among young children in eight low-resource settings. We tested 41 354 monthly non-diarrhoeal and diarrhoeal stools for C. difficile toxin genes (TcdA and TcdB) using quantitative PCR (qPCR) in 1715 children from birth to age two years in a multisite birth cohort study. We estimated the prevalence, cumulative incidence, and seasonality of C. difficile colonization and investigated the associations of C. difficile detection with risk factors of infection, markers of enteropathy, and growth. The prevalence of C. difficile detection was lower in diarrhoeal (2.2%; n = 151/6731) compared to non-diarrhoeal stools (6.1%; n = 2106/34 623). By 24 months of age, the cumulative incidence of C. difficile varied widely by site, with 17.9% (n = 44; Pakistan) to 76.3% (n = 148; Peru) of children having at least one positive stool. Only Bangladesh and Pakistan had seasonal differences in C. difficile detection. Female sex (adjusted risk ratio (aRR): 1.18; 95% CI: 1.02–1.35), cephalosporin use in the past 15 days (aRR: 1.73; 95% CI: 1.39–2.16), and treated water (aRR: 1.24; 95% CI: 1.02–1.50) were risk factors for C. difficile positivity. The presence of C. difficile was significantly associated with elevated faecal myeloperoxidase, neopterin, and α-1-antitrypsin, but no associations were found between C. difficile and child growth at 24 months of age. C. difficile colonization among children ages 0–2 years was variable across low-resource settings. Significant elevation of intestinal inflammation and barrier disruption markers associated with C. difficile detection suggests a subclinical impact of colonization.
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