The emergence of multidrug-resistant and hypervirulent Clostridium difficile clinical isolates

• Published in: Meta Gene 2020-06, Vol.24, p.100644, Article 100644
• Main Authors: Hindi, Nada Khazal Kadhim, Alsaadi, Zainab H., Abbas, Aalaa Fahim, Al-Saadi, Aamal Ghazi Mahdi
• Format: Article
• Language: English
• Subjects: Antibiotic resistance; Clostridium difficile; MDR; Virulence
• ISSN: 2214-5400; 2214-5400
• DOI: 10.1016/j.mgene.2019.100644

Although Clostridium difficile (C. difficile) is considered as common normal flora, antibiotic-associated infections and increasing antibiotic resistance are dramatic. The aim of this study was determination of C. difficile antibiotic resistance profile in two hospitals of Iraq. From June 2016 to April 2017 among a total of 580 stools samples, 47C. difficile were isolated from Iraqi Hospitals. Antibiotics susceptibility to 11 antibiotics was evaluated and the minimum inhibitory concentration (MICs) of vancomycin, rifampin and ciprofloxacin were determined by agar dilution method and MIC for metronidazole was determined by Test strips. The polymerase chain reaction (PCR) was performed to detect the toxin-encoding genes, tcdA, tcdB. Out of 580 specimens, 60 (10.3%) of the samples were positive for cdd-3 gene and 47 samples of them were viable as grown in culture media. The highest resistance rate was against meropenem (21.1%), vancomycin (17.2%) and imipenem (15.6%) and lowest rate was to ceftazidime (1.6%) and amikacin (0.8%) disks. High-level resistance to ciprofloxacin was detected in most of the C. difficile isolates, where two isolates were MDR by exhibiting resistance to ciprofloxacin, vancomycin, and metronidazole. Out of 47C. difficile isolates, 36 were toxigenic, among which 33 isolates being toxin A-positive and toxin B-positive (A+ B+) and 2 isolates being A+ B− and one isolate was A− B+. The emergence of MDR and toxigenic C. difficile suggesting hypervirulent strains in clinical settings is a concern. Resistance to vancomycin and metronidazole as last-line therapeutic resorts necessitate accomplishment of proper control strategies.