Colonization by Clostridium difficile of neonates in a hospital, and infants and children in three day-care facilities of Kanazawa, Japan.

The intestinal-carriage rates of Clostridium difficile in neonates hospitalized in the University Hospital's Center for Perinatal and Reproductive Health and in infants and children enrolled in two day-nurseries and a kindergarten were examined. Swab samples from the floors of these facilities were also analyzed to determine the extent of environmental contamination by this organism. C. difficile was found in the stool of only one of 40 neonates during the normal 1-week stay in the hospital after delivery. The isolate from the neonate was identical to that of her mother, as determined by PCR ribotyping, pulsed-field gel electrophoresis analysis, and toxin gene type, suggesting that the C. difficile-positive neonate acquired the organism from her mother rather than from the environment. By contrast, 47 (48.0%) of the 98 infants and children, comprising 50 enrolled in two day-nurseries who were >= 3 years old and 48 enrolled in a kindergarten who were 2-5 years old, carried C. difficile. The carriage rate in infants under 2 years of age was much higher (84.4%) than in children 2 years old and older (30.3%). When analyzed according to age group, the carriage rates were 100, 75.0, 45.5, 24.0, 38.5, and 23.5% in infants and children 0, 1, 2, 3, 4, and 5 years old, respectively. The observation that several children were colonized with the same type of C. difficile strain in each day-care facility, and that the floors of day-nursery A and kindergarten C were contaminated with C. difficile strains identical to those colonizing the intestines of children enrolled in those facilities suggests that cross-infection of C. difficile among children occurs through C. difficile-carrying children or their contaminated environments.

Colonization by Clostridium difficile of neonates in a hospital, and infants and children in three day-care facilities of Kanazawa, Japan / Colonización por Clostridium difficile en recién nacidos en un hospital y en niños menores de cinco años en tres guarderías de Kanazawa, Japón

The intestinal-carriage rates of Clostridium difficile in neonates hospitalized in the University Hospital's Center for Perinatal and Reproductive Health and in infants and children enrolled in two day-nurseries and a kindergarten were examined. Swab samples from the floors of these facilities were also analyzed to determine the extent of environmental contamination by this organism. C. difficile was found in the stool of only one of 40 neonates during the normal 1-week stay in the hospital after delivery. The isolate from the neonate was identical to that of her mother, as determined by PCR ribotyping, pulsed-field gel electrophoresis analysis, and toxin gene type, suggesting that the C. difficile-positive neonate acquired the organism from her mother rather than from the environment. By contrast, 47 (48.0%) of the 98 infants and children, comprising 50 enrolled in two day-nurseries who were ≤ 3 years old and 48 enrolled in a kindergarten who were 2-5 years old, carried C. difficile. The carriage rate in infants under 2 years of age was much higher (84.4%) than in children 2 years old and older (30.3%). When analyzed according to age group, the carriage rates were 100, 75.0, 45.5, 24.0, 38.5, and 23.5% in infants and children 0, 1, 2, 3, 4, and 5 years old, respectively. The observation that several children were colonized with the same type of C. difficile strain in each day-care facility, and that the floors of day-nursery A and kindergarten C were contaminated with C. difficile strains identical to those colonizing the intestines of children enrolled in those facilities suggests that cross-infection of C. difficile among children occurs through C. difficile-carrying children or their contaminated environments (AU)

Se examinaron las frecuencias de portadores intestinales de Clostridium difficile en recién nacidos y en niños menores de cinco años en las salas del centro de obstetricia y neonatología de un hospital universitario, en dos guarderías y en un parvulario. También se examinaron muestras de los suelos de estas instalaciones tomadas con torundas, para determinar la contaminación ambiental por el mencionado organismo. C. difficile se encontró solamente en las defecaciones de uno de los 40 recién nacidos durante la semana de estancia en el hospital después del parto. El aislado del recién nacido era idéntico al aislado de su madre en el ribotipado de PCR, en el análisis mediante electroforesis en gel de campo pulsado, y en el tipo de gen de la toxina. Esto sugiere que el recién nacido positivo para C. difficile adquirió el organismo de su madre y no del ambiente. Del total de 98 niños menores de cinco años estudiados (50 alumnos de una guardería, que tenían tres años o menos, y 48 alumnos de un parvulario, con edades entre dos y cinco años), 47 (48%) eran portadores de C. difficile. Cuando se analizó la frecuencia de portadores en niños menores de dos años de edad era más elevada (84,4%), mientras que en niños de dos o más años era menor (30,3%). Las frecuencias en los grupos de edades de 0, 1, 2, 3, 4, y 5 años fueron de 100, 75,0, 45,5, 24,0, 38,5, y 23,5% respectivamente. La observación de que en cada guardería hubiese varios niños colonizados con la misma cepa de C. difficile, y de que el suelo de la guardería A y el del parvulario C estuvieran contaminados con varios tipos de C. difficile idénticos a los que colonizaban el intestino de los niños menores de dos años, sugiere que existe una infección cruzada de C. difficile entre los niños. Esta infección se transmitiría en las instalaciones de la guardería a partir de los niños portadores de C. difficile o por contaminación del ambiente (AU)