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The Emergence of Metronidazole and Vancomycin Reduced Susceptibility in Clostridium Difficile Isolates in Iran Publisher Pubmed



Kouhsari E1, 2, 3 ; Douraghi M4 ; Krutova M5 ; Fakhre Yaseri H6 ; Talebi M1 ; Baseri Z1 ; Moqarabzadeh V7 ; Sholeh M1 ; Amirmozafari N1
Authors
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Authors Affiliations
  1. 1. Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  2. 2. Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
  3. 3. Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
  4. 4. Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
  6. 6. Research Center for Gastroenterology and Liver Disease, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
  7. 7. Department of Biostatistics, School of Health, Mazandaran University of Medical Sciences, Sari, Iran

Source: Journal of Global Antimicrobial Resistance Published:2019


Abstract

Objectives: Clostridium difficile (C. difficile) is the main causative agent of antibiotic-associated diarrhoea (AAD) and pseudomembranous colitis. The accumulation of antimicrobial resistance in C. difficile strains can drive C. difficile infection (CDI) epidemiology. This study was undertaken to evaluate the antimicrobial resistance patterns of toxigenic C. difficile isolates cultured from diarrhoeal stool samples of hospitalised patients with suspected CDI in three tertiary care hospitals in Tehran, Iran. Methods: Two hundred and fifty diarrhoeal stool samples were investigated by toxigenic culture using cycloserine-cefoxitin-fructose agar and the VERO cell line. Antimicrobial susceptibility to metronidazole, vancomycin, clindamycin, tetracycline, and moxifloxacin was performed by disk diffusion and Etest methods on Brucella Blood Agar supplemented with hemin and vitamin K. Results: Thirty-five stool samples (14.0%) proved positive using C. difficile toxigenic culture. According to Clinical and Laboratory Standards Institute breakpoints, the following resistance was identified in C. difficile isolates: metronidazole (2 of 35); moxifloxacin (7 of 35); clindamycin (18 of 35); and tetracycline (5 of 35). Using European Committee on Antimicrobial Susceptibility Testing breakpoints, three of 35 isolates showed reduced-susceptibility for vancomycin and 14 of 35 for metronidazole. In addition, the results showed a good correlation between the inhibition zone diameter (disk diffusion) and MIC values (Etest); Pearson correlation coefficient 0.7400.95 (P < 0.001). Conclusions: Multidrug resistance was observed in Iranian clinical toxigenic C. difficile isolates, including reduced susceptibility to first-line CDI treatment drugs. In addition, disk diffusion can be used as a cost-effective option for the antimicrobial susceptibility testing of C. difficile isolates. © 2019 International Society for Chemotherapy of Infection and Cancer
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