Dynamics of toxigenic Clostridium perfringens colonisation in a cohort of prematurely born neonatal infants.

Abstract:

BACKGROUND:Clostridium perfringens forms part of the human gut microbiota and has been associated with life-threatening necrotising enterocolitis (NEC) in premature infants. Whether specific toxigenic strains are responsible is unknown, as is the extent of diversity of strains in healthy premature babies. We investigated the C. perfringens carrier status of premature infants in the neonatal intensive care unit, factors influence this status, and the toxic potential of the strains. METHODS:C. perfringens was isolated by culture from faecal samples from 333 infants and their toxin gene profiles analysed by PCR. A survival analysis was used to identify factors affecting probability of carriage. Competitive growth experiments were used to explore the results of the survival analysis. RESULTS:29.4% of infants were colonized with C. perfringens before they left hospital. Three factors were inversely associated with probability of carriage: increased duration of maternal milk feeds, CPAP oxygen treatment and antibiotic treatment. C. perfringens grew poorly in breast milk and was significantly outperformed by Bifidobacterium infantis, whether grown together or separately. Toxin gene screening revealed that infants carried isolates positive for collagenase, perfringolysin O, beta 2, beta, becA/B, netB and enterotoxin toxin genes, yet none were observed to be associated with the development of NEC. CONCLUSIONS:Approximately a third of preterm infants are colonised 3 weeks after birth with toxin gene-carrying C. perfringens. We speculate that increased maternal breast milk, oxygen and antibiotic treatment creates an environment in the gut hostile to growth of C. perfringens. Whilst potentially toxigenic C. perfringens isolates were frequent, no toxin type was associated with NEC. TRIAL REGISTRATION:clinicaltrials.gov NCT01102738, registered 13th April 2010.

journal_name

BMC Pediatr

journal_title

BMC pediatrics

authors

Shaw AG,Cornwell E,Sim K,Thrower H,Scott H,Brown JCS,Dixon RA,Kroll JS

doi

10.1186/s12887-020-1976-7

subject

Has Abstract

pub_date

2020-02-18 00:00:00

pages

75

issue

1

issn

1471-2431

pii

10.1186/s12887-020-1976-7

journal_volume

20

pub_type

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