Colonization of the large bowel by Clostridium difficile in healthy infants: quantitative study

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Abstract
Colonization of the large bowel of healthy infants by C. difficle was studied. Feces were collected from 5 breast-fed and 5 formula-fed infants throughout the 1st yr of life, and levels of C. difficle were quantitated. Three breast-fed and 5 formula-fed infants were colonized for periods of between 8-42 wk; another infant harbored the organism only during wk 1. Colonization of breast-fed infants commenced before or during weaning, with levels reaching 103-105 organisms/g of wet feces. Colonization of formula-fed infants commenced before solid foods were given, with levels of 103-107 organisms/g of wet feces. Isolates from 8 of the babies were shown to produce cytotoxin in vitro. Single fecal specimens from 60 more children aged up to 4 yr were also examined; it was found that the carriage rate of C. difficile fell sharply after 1 yr of age, although in the 2nd yr it was still higher than in adults. These findings are discussed in relation to the microbial ecology of the large bowel and the paradox that levels of C. difficile in the large bowel of healthy infants are similar to those causing pseudomembranous colitis in patients.