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Prevalence, Risk Factors, and Sequelae of Asymptomatic Clostridioides difficile Colonization in Children with Cystic Fibrosis

  • Seth A. Reasoner
    Affiliations
    Division of Molecular Pathogenesis, Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, United States of America
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  • Irtiqa F. Fazili
    Affiliations
    Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
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  • Rachel Bernard
    Affiliations
    Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Monroe Carrell Junior Children's Hospital at Vanderbilt, Nashville, TN, United States of America
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  • Jacob M. Parnell
    Affiliations
    Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
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  • Andrew G. Sokolow
    Affiliations
    Division of Pediatric Pulmonary, Allergy, and Immunology, Department of Pediatrics, Monroe Carrell Junior Children's Hospital at Vanderbilt, Nashville, TN, United States of America
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  • Kelly F. Thomsen
    Affiliations
    Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Monroe Carrell Junior Children's Hospital at Vanderbilt, Nashville, TN, United States of America
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  • Kathryn M. Edwards
    Affiliations
    Division of Pediatric Infectious Diseases, Department of Pediatrics, Monroe Carrell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, United States of America
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  • Rebekah F. Brown
    Affiliations
    Division of Pediatric Pulmonary, Allergy, and Immunology, Department of Pediatrics, Monroe Carrell Junior Children's Hospital at Vanderbilt, Nashville, TN, United States of America
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  • Maribeth R. Nicholson
    Correspondence
    Corresponding author: Maribeth R. Nicholson, MD, MPH, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232.
    Affiliations
    Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Monroe Carrell Junior Children's Hospital at Vanderbilt, Nashville, TN, United States of America

    Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Published:December 28, 2022DOI:https://doi.org/10.1016/j.jcf.2022.12.014

      Highlights

      • The rate, risk factors, and sequelae of asymptomatic colonization by C. difficile are not well characterized in children with cystic fibrosis (CF).
      • Thirty-two percent of asymptomatic children with CF tested positive for C. difficile, with none developing symptomatic infection during 90-day follow-up.
      • Higher BMI and exposure to specific antibiotic classes (cephalosporins, fluoroquinolones, and vancomycin) were associated with C. difficile colonization.

      Abstract

      Patients with CF (pwCF) have high antibiotic use and an altered intestinal microbiome, known risk factors for infection with Clostridioides difficile. However, in adults with CF, C. difficile infection (CDI) is uncommon and asymptomatic colonization with C. difficile occurs frequently, for reasons that remain unclear. We investigated the rate, risk factors, and sequelae of asymptomatic C. difficile colonization in children with CF (cwCF). We identified that 32% of cwCF were colonized with C. difficile without acute gastrointestinal symptoms. Higher BMI and exposure to specific antibiotic classes (cephalosporins, fluoroquinolones, and vancomycin) were significantly associated with C. difficile colonization. No children developed symptomatic CDI in 90-days following enrollment.

      Keywords

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