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Clostridium Difficile Isolated From Faecal Samples in Patients With Ulcerative Colitis Publisher Pubmed



Shoaei P1 ; Shojaei H2 ; Jalali M3 ; Khorvash F1 ; Hosseini SM4 ; Ataei B5 ; Vakili B6 ; Ebrahimi F7 ; Tavakoli H8 ; Esfandiari Z9 ; Weese JS10
Authors
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Authors Affiliations
  1. 1. Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. School of Food Science and Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
  4. 4. Epidemiology and Biostatics Department, Isfahan University of Medical Sciences, Isfahan, Iran
  5. 5. Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  6. 6. Department of Microbiology, Science and Research Branch, Islamic Azad University, Tehran, Iran
  7. 7. Department of Microbiology, Islamic Azad University of Falavarjan, Isfahan, Iran
  8. 8. Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB, Canada
  9. 9. Department of Research and Development, Vice Chancellory for Food and Drug, Isfahan, Iran
  10. 10. Department of Pathobiology and Centre for Public Health and Zoonoses, Ontario Veterinary College, University of Guelph, Guelph, Canada

Source: BMC Infectious Diseases Published:2019


Abstract

Background: Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that is widely identified worldwide. This study aimed to investigate the phenotypic characterization and molecular typing of Clostridium difficile isolates among patients with UC at an inflammatory bowel disease clinic in Iran. Methods: In this cross-sectional study, conducted from April 2015 to December 2015, 85 UC patients were assessed for C.difficile infection (CDI). C. difficile isolates were characterized based on their toxin profile and antimicrobial resistance pattern. Multi-locus sequence typing analysis (MLST) and PCR ribotyping were performed to define the genetic relationships between different lineages of toxigenic strains. Results: The prevalence of C. difficile isolates was 31.8% (27/85) in patients, of those 15 patients (17.6%) had CDI. Three different sequence types (STs) identified based on MLST among the toxigenic isolates, that is ST54 (33.3%), ST2 (53.3%), and ST37 (13.6%). C. difficile strains were divided into four different PCR-ribotypes (012, 014, 017 and IR1). The most common ribotype was 014 accounting for 48.3% (7/15) of all strains. The strains isolated during the first episode and recurrence of CDI usually belonged to PCR ribotype 014 (ST2). A high rate of CDI recurrence (14.1%, 12/85) experienced in UC patients. Colonization of the gastrointestinal tract with non-toxigenic C. difficile strains was frequent among patients with mild disease. All C. difficile isolates were susceptible to metronidazole, and vancomycin, 86 and 67% of isolates were resistant to clindamycin and erythromycin respectively. There was no correlation between the toxin type and antibiotic resistance (p > 0.05). Conclusion: Overall CDI is rather prevalent in UC patients. All patients with CDI experienced moderate to severe disease and exposed to different antimicrobial and anti-inflammatory agents. Close monitoring and appropriate management including early detection and fast treatment of CDI will improve UC outcomes. © 2019 The Author(s).
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