Carriage of Clostridioides difficile in healthy infants in the community of Handan, China: A 1-year follow-up study

Clostridioides difficile may colonize healthy infants and young children asymptomatically and for the long-term. C. difficile genotypes and the rate and determinants of colonization differ substantially and vary among countries and regions. A 1-year follow-up study was performed to determine the incidence, kinetics and influencing factors of C. difficile intestinal colonization. Twenty-nine healthy infants (14 girls and 15 boys) living at home with their parents in Handan City were followed by survey from birth to 1 year of age, specifically from October 2014 through December 2015. C. difficile isolates were typed by PCR ribotyping and analyzed for the presence of toxin genes. During the follow-up study period in the first year of life, 20 of the 29 total enrolled infants acquired C. difficile. A total of 437 fecal samples were obtained, and 111 (25.4%) samples contained C. difficile, including 79 (71.2%) toxigenic strains. The toxigenic isolates comprised six PCR ribotypes, and two PCR ribotypes were identified as nontoxigenic strains. Our study showed that C. difficile colonization increase with age during the 12-month period, and the dominant toxigenic types of C. difficile isolates in infants were those involved in long-term colonization. Feeding patterns may affect the dynamic progress of C. difficile colonization. •A follow-up study involving 29 healthy infants was performed to define the rate and kinetics of C. difficile colonization.•Our study shows that the colonization rate of C. difficile in the intestine of infants within 12 months increases with age.•The dominant toxigenic types of C. difficile isolates in infants were those involved in long-term colonization.•C. difficile genotypes and the rate of colonization differ substantially and vary among countries and regions.•Feeding patterns might affect the dynamic progress of C. difficile colonization.