The iron content of the formula influences the number of Clostridium spp. in the large intestine of infants (57). Clostridium tertium is more often isolated from breast-fed infants than from either group of bottle-fed infants, and Clostridium butyricum is more frequently recovered from infants bottle fed with iron supplement than from breast-fed infants or infants bottle fed without iron supplement. Enhancement of bacterial growth by iron has been recognized for some Clostridium spp. (58) C. difficile and Clostridium paraputrificum were not isolated from breast-fed infants but were recovered from the stools of healthy bottle-fed infants. C. butyricum, C. paraputrificum, Clostridium perfringens, and the toxin of C. difficile have been implicated in the pathogenesis of necrotizing enteritis (59). Whether these organisms are primary pathogens or secondary invaders of an otherwise damaged intestinal mucosa remains unclear. However, it can be postulated that bottle-fed infants, especially those receiving an iron supplement, are at a greater risk for developing necrotizing enteritis caused by C. butyricum, C. difficile, and
C. paraputrificum than are breast-fed infants in cases of damaged intestinal mucosa.
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