Peer-reviewed article
The prevalence and molecular epidemiology of Clostridioides difficile in hospital-based pediatric populations in China.
Yu Zeng, Yining Shen, Fangfang Fan, Yiyue Liu, Tongxuan Su et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined the prevalence and genetics of Clostridioides difficile bacteria in stool samples from children across six Chinese hospitals. Researchers found the bacteria in 16.8% of samples, mostly in children without symptoms. The bacteria showed resistance to some antibiotics but remained vulnerable to common treatments. The study notes that infected children may act as reservoirs spreading resistant strains in hospitals.
Key points
- C. difficile was detected in 16.8% of pediatric stool samples, with 13.0% asymptomatic carriers and 0.98% confirmed infections
- Highest asymptomatic carriage rate was in children aged 1-2 years at 29.3%
- High resistance to clindamycin (64.5%) but all isolates remained susceptible to metronidazole and vancomycin
- Genetic analysis identified nine distinct lineages with ST3 being the most common sequence type
- Evidence of possible hospital-based transmission detected in 12.0% of asymptomatic carriers
Limitations
This is a microbiological surveillance study focused on bacterial prevalence and genetics rather than child health outcomes or interventions. It does not measure the actual health impact of C. difficile colonisation on children's well-being or evaluate any health intervention.
Abstract
A multicenter cross-sectional study was conducted across six Chinese hospitals between September 2023 and April 2024 to investigate the prevalence, molecular epidemiology, antimicrobial resistance (AMR) and genetic relatedness of C. difficile in pediatric populations. Among 1,442 stool samples collected, 242 C. difficile isolates were recovered (16.8%), including 188 from asymptomatic carriers (13.0%) and 11 from confirmed C. difficile infection (CDI) cases (0.98%). The highest rate of asymptomatic carriage was observed in children aged 1-2 years (29.3%). Multilocus sequence typing (MLST) identified ST3 as the predominant sequence type (30.6%), followed by ST42, ST54, ST2, ST102, and ST110. Core genome phylogenetic analysis revealed nine distinct genetic lineages, with lineage VI being the most prevalent among CDI cases. High resistance to clindamycin (64.5%) was observed, primarily mediated by ermB, while all isolates remained susceptible to metronidazole and vancomycin. Moxifloxacin resistance (10.7%) was associated with gyrA T82I mutations, particularly in toxigenic ST3 strains. Transposon analysis indicated ST-specific carriage of AMR genes, with Tn6218(ermB) prevalent in nontoxigenic ST3 isolates and Tn5801 (tet(M)) predominant in ST54. Genomic relatedness (≤2 SNPs) was detected in 12.0% of asymptomatic carriers, with most links associated with hospital-wide contact, suggesting possible transmission events. This study highlights the importance of asymptomatic colonized children as a reservoir for C. difficile, maintaining resistant lineages and disseminating AMR, thereby underscoring the need for enhanced surveillance and targeted antimicrobial stewardship in Chinese healthcare settings.