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Characterization of Clostridioides Difficile Isolates Recovered From Hospitalized Patients and the Hospitals Environment and Air: A Multicenter Study Publisher Pubmed



Aliramezani A1 ; Talebi M2 ; Golbabaei F3 ; Baghani A1 ; Marjani M4 ; Afhami S5 ; Hajabdolbaghi M6 ; Boroumand MA7 ; Kuijper EJ8 ; Douraghi M1, 9
Authors
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Authors Affiliations
  1. 1. Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Occupational Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. Department of Infectious Diseases, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  7. 7. Department of Pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
  8. 8. Department of Medical Microbiology, Center for Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
  9. 9. Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran

Source: Anaerobe Published:2019


Abstract

In healthcare settings, contamination of environment with toxigenic and hypervirulent Clostridioides difficile strains is a serious concern. Here, we assessed whether patients with C. difficile have a role to play in the dissemination of C. difficile in our settings or other sources are implicated in its circulation. A total of 700 fecal specimens and 1435 environmental samples from surfaces, equipment and air of rooms occupied by patients suspected of C. difficile infection were taken from 4 tertiary hospitals in Tehran, Iran between April 2016 and August 2017. Antibiotic susceptibility testing and detection of resistance genes were performed for the environmental isolates. The clinical and environmental isolates of C. difficile were subjected to Pulsed Field Gel Electrophoresis (PFGE) analysis. Forty three (6.14%) and 2 (0.13%) isolates of C. difficile were recovered from the clinical and environmental samples, respectively. In the clinical settings, 2 patients were suspected of recurrent C. difficile infection. Thirty distinct pulsotypes were found among the C. difficile isolates including 28 singletons and 2 common types. One of the two environmental isolates was isolated from floor in the Medical ward, of pulsotype/ribotype/toxinotype PT10/New ribotype/toxinotype V, harbored cdtA/B and tcdC-A, and resistant to ciprofloxacin. The other one was isolated from air of a room in ICU, assigned to PT11/RT001/toxinotype 0, belonged to tcdC-sc3 genotypes and resistant to metronidazole. The environmental isolates did not generate amplicons in PCR assays targeting vanA and nim genes. This study provided evidence for dissemination of genetically diverse strains of C. difficile in hospitalized patients, presence of C. difficile in hospital air, existence of binary toxin positive/antibiotic-resistant isolate on the floor and intra-hospital dissemination of this pathogen. © 2019 Elsevier Ltd
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