Infants between 6-12 months old had the highest prevalence of C difficile detection.
The prevalence of Clostridioides difficile infections (CDI) is greatest among young infants, but ultimately decreases as the child continues to age, according to new research.
A team, led by Sarah R. Tougas, BScN, MD, Cumming School of Medicine, Department of Pediatrics, University of Calgary, assessed the prevalence of CDI detection among asymptomatic children across different age groups.
C difficile infections have significantly increased in recent decades among the pediatric population. For example, the rate of C difficile infection detection increased from 2.6-32.6 cases per 100,000 individuals between 1991-2009 in Minnesota.
However, it remains a challenge to distinguish colonization from injection in this patient group because many children whose stool samples test positive for C difficile are colonized, but not truly infected.
Many clinicians believe C difficile infections are asymptomatic in the majority of infants and young children, but this theory has not been stratified by age in the past.
In the systematic review and meta-analysis, the researchers culled various databases for C difficile studies that reported C difficile testing among asymptomatic children between 1990-2020. The investigators identified 95 studies involving 19,186 patients that fit the inclusion criteria.
The data was extracted, screened, and duplicated independently by 2 reviewers, who used Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines and pooled the data using a random-effects model.
The investigators sought primary outcomes of the prevalence of C difficile detection among asymptomatic children. They also sought secondary outcomes of the prevalence of toxigenic and nontoxigenic strains of C difficile and the prevalence of C difficile detection stratified by geographic region, income status, testing method, and year of testing.
The rates of detection of toxigenic or nontoxigenic CDI was the largest among individuals between 6-12 months old (41%; 95% CI, 32-50%). The rates also decreased among children between 5-18 years old (12%; 95% CI, 7-18%).
Toxigenic colonization was lower among infants between 6-12 years old, peaking at 14% (95% CI, 8-21%) and decreased to 6% (95% CI, 2-11%) among individuals older than 5 years old.
There were some differences found based on geographic regions (North and South America vs Europe: β, −0.151, P = .001; North and South America vs Western Pacific: β, 0.136, P = .007).
However, there was no differences found based on testing method (culture vs polymerase chain reaction: β, 0.069, P = .052; culture vs enzyme immunoassay: β, −0.178, P = .051). This was also true for income class (low-middle income vs high income: β, −0.144, P = .23; upper-middle vs high income: β, −0.020, P = .64) and period (before 1990 vs 2010-2020: β, −0.125, P = .19; 1990-1999 vs 2010-2020: β, −0.037, P = .42; 2000-2009 vs 2010-2020: β, −0.006P = .86).
“In this systematic review and meta-analysis, C difficile colonization rates among children were greatest at 6 to 12 months of age and decreased thereafter,” the authors wrote. “These estimates may provide context for interpreting C difficile test results among young children.”
The study, “Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children,” was published online in JAMA Pediatrics.