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

Abstract

Clostridioides difficile infection (CDI) remains a major healthcare problem worldwide, however, little is known about CDI epidemiology in Iran. Between December 2004 and November 2018, 3649 stool samples were collected from patients in 69 hospitals and medical centres in Tehran and were cultured for the presence of C. difficile; isolates were characterized by PCR ribotyping and toxin genes detection. A total of 582 C. difficile isolates were obtained and the overall CDI prevalence was 15.9%; 290 (49.8%) cases were healthcare-associated (HA) and 292 (50.2%) cases were community-associated (CA). Of these, DNA of 513 isolates submitted for ribotyping. The ribotype and/or WEBRIBO type could be assessed in 366 (62.9%) isolates. The most frequent RTs were 001 (n = 75, 12.9%), 126 (n = 65, 11.2%) and 084 (n = 19, 3.3%); the toxin gene profile tcdA + B + /cdtA + B + (n = 112, 19.2%) was the most common. Fifteen C. difficile isolates (2.6%) did not carry any toxin genes. There was no difference between frequently found RTs in HA-CDI and CA-CDI, except for RT 029 which was more likely to be associated with healthcare origin (12/15, p-value = 0.02). No isolate of RTs 027 or 078 was identified. Importantly, RTs 031, 038, 039, 084, 085 reported previously as RTs with an absence of toxin genes, revealed the presence of toxin genes in our study. Using Simpson's reciprocal index of diversity, we found that RT diversity decreased as the prevalence of the RT 084 increased (R = −0.78, p-value = 0.041). Different patterns in CDI epidemiology underscore the importance of local surveillance and infection control measures in Tehran healthcare settings.

How Does COVID-19 Pandemic Impact on Incidence of Clostridioides difficile Infection and Exacerbation of Its Gastrointestinal Symptoms?

“…CDI is an important global infectious disease caused by a toxin-releasing obligate anaerobic organism after long-term use of broad-spectrum antibiotics, absence of antimicrobial stewardship and hospital overcrowding (43)(44)(45). Besides, C. difficile bacteria produce two major exotoxins, toxin A (TcdA) and toxin B (TcdB), which are both glucosylating toxins responsible for CDI symptoms, including intestinal injury, mucosal inflammation and marked neutrophil recruitment.…”

Molecular epidemiology and antimicrobial resistance patterns of Clostridioides difficile isolates in Algerian hospitals

“…The remaining non toxigenic ribotype isolated with a lesser frequency (n = 1), RT 039, was previously reported as most common in patients with cystic fibrosis in Western Australia [34], and was also detected in health care settings in Iran [35], and Kuwait [36]. Surprisingly, several isolates of RT 039 from Iran were found to carry the toxin genes [35].…”

“…Isolates of the RT 014 were the most prevalent ribotype in many European countries, where it was reported as responsible for CDI outbreaks in humans, and also commonly associated with animals and different environments [37,[39][40][41][42]. The RT 014 was also detected in several countries in the Middles-East, Iran [35], Lebanon [8] and Qatar [28]; whereas in the African continent it was reported only in Algeria [10] and South Africa [43].…”

Molecular characterization of pathogenicity locus (PaLoc) and tcdC genetic diversity among tcdAB Clostridioides difficile clinical isolates in Tehran, Iran

“…In our previous study that used a large collection of C. di cile isolates, RT 001 (12.9%), RT 126 (11.2%), and RT 084 (3.3%) were the most frequent RTs identi ed in CDI patients across different hospitals and medical centers in Tehran [39]. In a recent study by Baghani et al, RT 001 (32.3%) and RT 126 (9.2%) were also reported as the most common RTs isolated from patients with CDI in Tehran [40].…”