Prevalence, characteristics and antimicrobial susceptibility patterns of Clostridium difficile isolated from hospitals in Iran.

Abstract Objective Clostridium difficile is the major growing cause of nosocomial diarrhea that known as C. difficile infection (CDI). This study investigated the prevalence and antimicrobial resistance patterns of C. difficile isolated from patients suffering from diarrhoea in Iran, between 2016- 2018. Methods A total of 151 stool specimens were collected and screened for the presence of C. difficile and discovered its toxins by culture, EIA, and PCR methods. Antimicrobial susceptibility testing was performed for twelve antibiotics (metronidazole, vancomycin, clindamycin, tetracycline, erythromycin, ciprofloxacin, levofloxacin, moxifloxacin, fusidic acid, piperacillin, piperacillin/tazobactam and rifampicin) by disk diffusion method, according to the CLSI, EUCAST, and CA-SFM guidelines. Results Out of 151 patients, 66 (43.71%) cases were positive for C. difficile by PCR. Two (1.32%) patients were only positive for C. difficile toxins based on EIA. A total of 292 clostridial isolates were obtained from specimens by culture, where 133 (45.55%) isolates finally confirmed as C. difficile by PCR. One hundred and seven (88.43%) isolates were resistant to at least three antibiotics and defined as multidrug resistant strains. Different and diverse resistant patterns to the antimicrobial drugs were seen among the isolates. Conclusions This is the first report of the isolation of C. difficile from different governmental hospitals of Iran and indicates that CDI might be an important nosocomial infection in different hospital wards. Moreover, this study provides a good comprehensive picture of the MDR phenotype characteristics of C. difficile isolates in Iran.