Molecular epidemiology of Clostridium difficile infection in Iranian hospitals

Abstract

BackgroundClostridium difficile infection (CDI) is known as one of the most important causes of nosocomial infections. The main objective of this study was to evaluate the presence of Clostridium difficile in the stool of hospitalized patients with diarrhea as well as in their environments.MethodsC. difficile isolates were characterized according to the presence of toxin genes and antibiotic resistance. Multilocus Sequence Typing Analysis (MLST) was applied for finding the genetic polymorphism and relationship among strain lineages.ResultsA total of 821 samples (574 stools and 247 swabs) were collected between April 2015 and May 2017. The prevalence of C. difficile isolates was 28.6% (164/574) in patients and 19% (47/247) in swabs taken from medical devices, hands of healthcare workers and skin patient sites. Finally, 11.5% (66/574) toxigenic C. difficile strains isolated from stool samples of inpatients and 4.4% (11/247) from hands of healthcare workers and skin patient sites. All the toxigenic isolates were inhibited by a low concentration of vancomycin (MIC < 0.5 μg/ml). About 43% (33/77) and 39% of isolates were resistant to Clindamycin and moxifloxacin respectively. All isolates were susceptible to metronidazole. Toxigenic C. difficile strains were analyzed by MLST and were divided into 4 different STs. The detected types were ST-54 (57.9%), followed by ST-2 (31.6. %), ST-15 (5.3%) and ST-37 (5.3%), while none of the isolates were identified as ST-1 or ST-11. Significant risk factors for CDI appear to be advanced age, undergoing chemotherapy, previous surgery, and residence in the nursing home.ConclusionsCDI is common in Iran and further studies are recommended to monitor its epidemiological variations. Moreover, greater attempts must be made to encourage antibiotic stewardship by healthcare workers and the public.

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].…”

Isolation and toxin gene detection of Clostridium (Clostridioides) difficile from traditional and commercial quail farms and packed quail meat for market supply – Short communication

“…However, in quail meat no toxigenic isolates could be detected. Concerning the fact that 'hypervirulent' strains were absent, it should be taken into account that this finding is in line with most studies targeting humans in Iran except for RT078 in one study (Jalali et al, 2012) as they seem to be of minor importance in Iran (Azimirad et al, 2017;Kouhsari et al, 2019;Shoaei et al, 2019).…”

“…It is of note that RT001 (Azimirad et al, 2017;Kouhsari et al, 2019), RT014/020 [both RTs correspond to sequence type 2 in the respective study (Shoaei et al, 2019)], RT039 (Kouhsari et al, 2019) and RT078 (Jalali et al, 2012) have been detected in the Iranian population. However, most studies focused predominantly on chicken, ostriches and turkeys, and data for other poultry species such as quails are scarce.…”

<p>Phenotypic and Genotypic Characteristics of <em>Clostridium difficile</em> Isolates in Patients with Type 2 Diabetes in Iran</p>

“…Most of CDI in previous studies were found to be due to A+B+ strains (ST2, ST54) and A − B + strains (ST37, ST15). [25][26][27] The main epidemic genotypes described recently in different regions of China were ST54, ST37, ST3, ST2 and ST35, however remarkable variations in molecular epidemiology of C. difficile across different countries worldwide have been observed. 1 For example, in Korea and Japan, ST17 and ST2 are the predominant types; however, ribotype 027/ ST1 is the most common C. difficile strain in the United States and Europe, for most Asian countries, ST1 cases have only been reported sporadically.…”

“…The treated stool samples were inoculated onto the CDMN-agar surface supplemented with 7% sheep blood and incubated anaerobically for 48 h at 37C°. Plates were examined for suspect colonies with 2-3 mm in diameter, the characteristics p-cresol odor unique to C.difficile, ultraviolet light (365 nm) for yellow fluorescence within 1 hr of removal from the anaerobic atmosphere, Gram stain morphology, and positive reaction to L-proline aminopeptidase test (Prodisk, Remeb, Lenexa, KS,USA) 16,27…”