Highly Antibiotic-Resistant Clostridium Difficile Isolates From Iranian Patients Publisher Pubmed



Baghani A¹ ; Ghourchian S¹ ; Aliramezani A¹ ; Yaseri M² ; Mesdaghinia A^{3, 4} ; Douraghi M^{1, 5}
Source: Journal of Applied Microbiology Published:2018

Abstract

Aims: Little is known about the resistance rate and susceptibility profile of Clostridium difficile isolates in Iran. Therefore, the aim of present study is to assess the rate of drug-resistant C. difficile. Methods and Results: During a 6-year period, four hospitals submitted 735 stool specimens from patients suspected for C. difficile infections to the anaerobic bacteriology laboratory. The 46 C. difficile isolates were subjected to disc diffusion and minimum inhibitory concentration (MIC) Test Strips. All isolates were susceptible to vancomycin (VAN) while the highly resistant phenotypes of metronidazole (MTZ) (67·4%), moxifloxacin (78·3%), ciprofloxacin (69·5%) and tetracycline (82·6%) were observed. Of more concern, 67·3% of C. difficile isolates displayed multidrug-resistant phenotypes. More than half of the isolates (n = 27, 58·6%) were coresistant to ciprofloxacin and moxifloxacin. The MIC90 of VAN was ≤2 mg l−1, whereas this value for MTZ, ciprofloxacin, moxifloxacin and tetracycline was higher than the resistance breakpoints. According to the comparison of interpretive categories for two tests, the categorical agreement was less than 90% for VAN, ciprofloxacin and tetracycline. Conclusions: The disc diffusion method can be used to detect the isolates with reduced susceptibility to MTZ or moxifloxacin. The high rate of resistance to fluoroquinolones highlights the possibility of the emergence of hypervirulent strains in our settings. Significance and Impact of the Study: This study provides data regarding the high level of resistance against multiple antibiotics except VAN. © 2018 The Society for Applied Microbiology