Frequency of Toxin Genes and Antibiotic Resistance Pattern of Clostridioides difficile Isolates in Diarheal Samples among Hospitalized Patients in Hamadan, Iran
Gastroenterology and Hepatology from Bed to Bench,
8 March 2021
Aims: This study was designed to investigate the prevalence of Clostridioides difficile, toxin-producing strains and antibiotic resistance patterns in diarrheal samples from hospitalized patients in Hamadan, West of Iran.
Background: Today, concerns on Clostridioides difficile infection have increased significantly due to improper use of antibiotics, as well as due to it’s toxins, spore form and antibiotic resistance, and has become a progressive health concern.
Material and Methods: In this case-sectional study, a total of 130 diarrhea samples of patients admitted to different wards of three hospitals in Hamadan from November 2018 to September 2019 were collected. After confirmation of Clostridioides difficile colonies by culturing on CCFA medium and PCR, the presence of toxin encoding genes (tcdA, tcdB), and Binary toxin genes (cdtA and cdtB) was detected by PCR. The antibiotic resistance of the isolates to metronidazole, vancomycin and clindamycin was determined using agar dilution method.
Results: Out of 130 diarrhea samples collected from hospitalized patients, 16 (12.3%) C. difficile was isolated. PCR results were positive for two toxin-producing genes; tcdA and tcdB, in all (100%) C. difficile isolates and binary toxins include cdtB and cdtA was detected in 8 (50%) and 6 (37.5%) isolates, respectively. The results of antibiotic susceptibility testing showed, resistance to metronidazole and clindamycin antibiotics in 3 (18.75%) and 2 (12.5%) isolates, respectively, and 3(18.75%) of isolates showed intermediated resistance to vancomycin.
Conclusion: The results of this study showed toxigenic C. difficile with tcdA+/ tcdB+ profile is the cause of a number of nosocomial diarrheas in our area and clinical laboratories should routinely perform C. difficile diagnostic tests on diarrhea specimens of hospitalized patients. Resistance to metronidazole and clindamycin should be considering as a warning to prevent the irrational administration of these antibiotics and thus prevent the spreading of C. difficile in hospitalized patients.
- Clostridioides difficile, tcdA, tcdB, Binary toxin, Antibiotic resistance
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