Molecular characterization of nosocomial Clostridium difficile infection in pediatric ward in Iran

Abstract

Clostridium difficile is recognized as a major cause of nosocomial acquired antibiotic-associated diarrhea and pseudomembranous colitis. It is a significant financial burden on modern healthcare resources. This study aimed to assess the molecular characterization of C. difficile strains isolated from children under 5 years old suffered from nosocomial diarrhea. One hundred diarrheic and 130 non-diarrheic fecal samples were collected from pediatrics less than 5 years old. Samples were cultured and C. difficile isolates were subjected to the PCR technique to study the distribution of ribotypes of C. difficile using P3 and P5 primers. Fifty-two out of 100 samples (52 %) were positive for C. difficile. The prevalence of bacterium in healthy children was 4.61 %. Total prevalence of C. difficile in diarrheic girls and boys were 48.9 and 54.7 %, respectively. Thirteen to twenty-four month age children had the highest prevalence of C. difficile. The most commonly detected ribotypes in the C. difficile isolates of Iranian pediatrics were RT027 (11.52 %), R1 (9.61 %) and R13 (7.68 %). The ribotypes of all of the six bacterial isolates of healthy children was not diagnosed. According to the presence of C. difficile and R27 ribotype, a continued genotype surveillance of this bacterium is necessary to monitor changes in the prevalence of certain strains and to identify the emergence of new strains that could affect future vaccine strategies.

Clostridioides difficile ribotypes 001 and 126 were predominant in Tehran healthcare settings from 2004 to 2018: a 14-year-long cross-sectional study

“…In our study the prevalence of CDI and the distribution of the causative RTs differed greatly between hospitals in various districts of Tehran. Compared to previous data from Iran, a noticeable heterogeneity was observed among published studies particularly in terms of the study population and the prevalence of CDI that varied from 6.14% to 52% [20][21][22][31][32][33][34]. Compared to other countries, the prevalence of CDI in our study (15.9%) was lower than that reported in Europe, America and the Middle East [28,[35][36][37].…”

“…In order to monitor the emergence of new RTs or identify a common RT cluster in a suspected CDI outbreak, effective CDI surveillance requires the collection of epidemiological data that includes the characterization of causative C. difficile strains and a capillary gel-based electrophoresis (CE-ribotyping), which is the recommended typing method [18,19]. Information on the molecular epidemiology of CDI in Iran, especially with a longitudinal perspective, is limited [20][21][22]. Therefore, in order to obtain data on CDI epidemiology and distribution of C. difficile RTs in Tehran healthcare settings, and to identify the risk factors for CDI development in Iranian population, we performed a 14-year-long cross-sectional study on patients with diarrhea between December 2004 and November 2018.…”

Detection, Ribotyping and Antimicrobial Resistance Properties of Clostridium difficile Strains Isolated From The Cases of Diarrhea

“…Studies which have been done in this field in Iran are scarce. Khoshdel et al (2015) (23) revealed that 52% of diarrheic and non-diarrheic stool samples of Iranian children were positive for C. difficile which was entirely higher than our results. They showed that boys and 13 to 24-month age children had the higher prevalence of C. difficile .…”

Molecular typing of Clostridioides difficile isolates from clinical and non‐clinical samples in Iran

“…A recent study conducted on 400 pediatric stool specimens in Iran reported a high prevalence for R27 (14.28%), R1 (10.71%), R12 (7.14%), R13 (7.14%), and R18 (7.14%) (21). In another study in Iran, Khoshdel et al (2015) (22) reported that the most commonly detected RTs in the C. difficile isolates of pediatrics were RT027 (11.52%), RT01 (9.61%), and RT013 (7.68%). In a teaching hospital-based study (23) (between 2010 and 2011), 11 different ribotyping patterns were identified (IR1-10, 078, 014), and RT078 was the most common (21%).…”

“…isolates. The incidence of tcdA À /tcdB + C. difficile strains is extensively increasing and ranges from 3% to 92% worldwide (22). In China, Huang et al reported that 33.3% of 75 toxigenic isolates were tcdA À /tcdB + (32).…”