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Antimicrob Resist Infect Control. 2019 Jan 14;8:12. doi: 10.1186/s13756-018-0454-6. eCollection 2019.

Molecular epidemiology of Clostridium difficile infection in Iranian hospitals.

Author information

1
1Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
2
2Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
3
3Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
4
4Epidemiology and Biostatics Department, Isfahan University of Medical Sciences, Isfahan, Iran.
5
5Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
6
6Department of Biology, University of British Columbia, Kelowna, Canada.
7
7School of Food Science and Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran.
8
8Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Canada.

Abstract

Background:

Clostridium 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.

Methods:

C. 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.

Results:

A 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.

Conclusions:

CDI 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.

KEYWORDS:

Clostridium difficile infection; Molecular characterization; Multilocus sequence typing analysis (MLST); Risk factor

Conflict of interest statement

The study was approved by the human research ethics committee at Isfahan University of Medical Sciences and the study was carried out in accordance with the approved guidelines.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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