Clostridioides (Clostridium) difficile carriage in asymptomatic children since 2010: a narrative review

Since 2010, there have been relatively scanty reports on Clostridioides (Clostridium) difficile asymptomatic colonization in children, especially in those aged >2 years. We evaluated asymptomatic C. difficile carriage in children according to literature data since 2010 and added our results for 61 asymptomatic Bulgarian children aged 2-17 years. Data analysis indicated that carriage is usually the most frequent in the youngest children aged ≤2 years, thereafter decreasing with intestinal microbiota establishment. However, the colonization rates are highly variable, ranging from 0-10% to 30-80%, according to the country, age group and underlying diseases and other concurrent conditions. In our study on older children (mean age, 6.9 years), the colonization rate was 6.6% and no toxigenic C. difficile were found. Among the reviewed reports, in many studies, toxigenic C. difficile carriage was low (0-13%), but much higher (15->54%) in children with inflammatory bowel disease (IBD) and oncological diseases. Binary positive carriage was rare or absent. The risk factors for C. difficile colonization included younger age, dysbiosis, present/recent hospitalization during previous 3 months, present/previous antibiotic or proton pump inhibitor use, underlying diseases such as IBD or oncological diseases as well as environmental contamination and tube feeding. Contamination control and breast feeding were protective factors. Probiotic plus prebiotic use and dietary changes may be beneficial. Briefly, since C. difficile carriage may be a potential source of infections, regular monitoring of colonization, especially of the toxigenic C. difficile is necessary to assess risks of clinically expressed diseases.