Clostridium difficile Whole Genome Sequencing Reveals Limited Transmission Among Symptomatic Children: A Single-Center Analysis Journal Article

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Authors: Kociolek, L. K.; Gerding, D. N.; Espinosa, R. O.; Patel, S. J.; Shulman, S. T.; Ozer, E. A.
Article Title: Clostridium difficile Whole Genome Sequencing Reveals Limited Transmission Among Symptomatic Children: A Single-Center Analysis
Abstract: Background: Although pediatric Clostridium difficile infections (CDI) are increasing, C. difficile transmission patterns among children are poorly understood. Methods: We performed whole genome sequencing (WGS) on C. difficile isolates collected from children diagnosed with CDI between Dec. 2012 and Dec. 2013 at a single academic medical center. Genome sequences of isolates from CDIs diagnosed gt;/= 8 weeks after study initiation were compared to all study isolate genome sequences. Among patients with isogenic isolates (/= 8 weeks after study initiation, only 10 (11.9%) were caused by a strain isogenic to another cohort CDI isolate (putative transmission events). Proportions of each CDI class putatively associated with transmission were: hospital-onset healthcare facility-associated (HCFA), 2/16 (12.5%); community-onset HCFA, 1/17 (5.9%); indeterminate, 1/11 (9.1%); community-associated (CA), 5/40 (12.5%); and recurrent, 1/21 (4.8%). Transmission events among CA and HCFA CDIs were similarly infrequent (5/40 [12.5%] vs. 3/33 [9.1%], p=0.64). Shared healthcare facility exposures were only identified among 7/10 putative transmission events. Potential community transmission (same postal code) was not identified. Conclusions: WGS identified a highly diverse group of C. difficile isolates among children with CDI, including those with HCFA CDI. C. difficile transmission among symptomatic children was very uncommon, and among putatively transmitted cases, investigation of shared healthcare exposures often did not identify a potential transmission source.
Journal Title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591; 1058-4838
Publisher: . Published by Oxford University Press for the Infectious Diseases Society of America  
Journal Place: United States
Date Published: 2018
Language: eng
DOI/URL:

10.1093/cid/ciy060
Notes: LR: 20180308; CI: (c) The Author(s) 2018; JID: 9203213; OTO: NOTNLM; 2017/12/17 00:00 [received]; 2018/01/26 06:00 [entrez]; 2018/01/26 06:00 [pubmed]; 2018/01/26 06:00 [medline]; aheadofprint