Rates of C Difficile Highest in Infancy, Decline During Childhood


C difficile colonization rates among children were greatest at 6 to 12 months of age but decreased among children older than 5 years of age.

Clostridioides difficile (C diff) infection prevalence is highest among young infants, but diminishes as children advance in age, according to research published in JAMA Pediatrics.

The systematic review and meta-analysis searched various databases for C diff testing data among asymptomatic children between 1990 and 2020. The investigators found 95 studies that included 19,186 patients who fit the inclusion criteria.

The data were extracted, screened, and duplicated independently by 2 reviewers via Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines and pooled the data using a random-effects model.

The investigators searched for primary outcomes of the prevalence of C diff detection among asymptomatic children. They also sought secondary outcomes for the prevalence of toxigenic and nontoxigenic strains of C diff and the prevalence of C diff detection stratified by geographic region, income status, testing method, and year of testing.

The studies showed that rates of detection for toxigenic or nontoxigenic C diff were greatest among infants aged 6 to 12 months (41%; 95% CI, 32%-50%) but declined to 12% (95% CI, 7%-18%) among children 5 to 18 years of age. The prevalence of toxigenic C diff colonization was lower, reaching a peak of 14% (95% CI, 8%-21%) among infants aged 6 to 12 months and declining to 6% (95% CI, 2%-11%) among children older than 5 years of age.

C diff prevalence varied by geographic region (i.e., 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 difference by testing method (ie, culture vs polymerase chain reaction: β, 0.069, P = .052; culture vs enzyme immunoassay: β, −0.178, P = .051), income class (low-middle income vs high income: β, −0.144, P = .23; upper-middle vs high income: β, −0.020, P = .64), or 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, −0.006, P = .86), the study authors wrote.

“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 concluded. “These estimates may provide context for interpreting C difficile test results among young children.”

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