Abstract

Clostridioides difficile colonization is common in infancy, yet factors influencing early-life carriage remain controversial, particularly in low and middle-income settings where epidemiological data are limited. This cross-sectional epidemiological study investigated the carriage rate of C. difficile among infants in four Local Government Areas of Lagos State, Nigeria, and evaluated the association between mode of feeding and colonization. A total of 134 infants aged between one day and 12 months were enrolled. Stool samples were processed for the isolation of C. difficile using alcohol shock treatment, selective and non-selective anaerobic culture, and isolates were identified by conventional biochemical testing, API 20A, and latex agglutination. Overall, C. difficile was isolated from 53 infants, giving a carriage rate of 39.6% (95% CI: 31.9–48.7%). Carriage varied by location, with the highest rate observed in Mushin (55.0%; 95% CI: 33.2–76.8%) and the lowest in Ikeja (30.2%; 95% CI: 16.6–43.8%). Exclusively breastfed infants had a significantly lower carriage rate (28.3%; 95% CI: 17.0–39.6%) compared with infants who were not exclusively breastfed (48.6%; 95% CI: 37.2–60.0%) (p < 0.05). Although colonization was frequent, no evidence of clinically significant disease was observed. These findings indicate that C. difficile colonization is common among infants in Lagos and that exclusive breastfeeding is associated with reduced carriage, supporting ongoing public health advocacy for exclusive breastfeeding in early life.