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

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Title: Dynamics of toxigenic Clostridium perfringens colonisation in a cohort of prematurely born neonatal infants
Authors: Shaw, A
Cornwell, E
Sim, K
Thrower, H
Scott, H
Brown, J
Dixon, R
Kroll, JS
Item Type: Journal Article
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.
Issue Date: 18-Feb-2020
Date of Acceptance: 12-Feb-2020
URI: http://hdl.handle.net/10044/1/77931
DOI: 10.1186/s12887-020-1976-7
ISSN: 1471-2431
Publisher: BioMed Central
Journal / Book Title: BMC Pediatrics
Volume: 20
Copyright Statement: © 2020 The Author(s). Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: Winnicott Foundation
Micro Medical Ltd
Funder's Grant Number: N/A
Keywords: Science & Technology
Life Sciences & Biomedicine
Clostridium perfringens
Breast milk
Necrotising enterocolitis
Breast milk
Clostridium perfringens
Necrotising enterocolitis
1114 Paediatrics and Reproductive Medicine
Publication Status: Published
Article Number: 75
Online Publication Date: 2020-02-18
Appears in Collections:School of Public Health