Clostridium difficile isolated from faecal samples in patients with ulcerative colitis

Parisa Shoaei,Zahra Esfandiari,Sayed Mohsen Hosseini,Behrooz Ataei,Hasan Shojaei,Fatemeh Ebrahimi,Bahareh Vakili,Mohammad Jalali,Farzin Khorvash,Hossein Tavakoli,J Scott Weese

doi:10.1186/s12879-019-3965-8

Abstract

BackgroundUlcerative 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.MethodsIn 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.ResultsThe 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).ConclusionOverall 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.

Highlights

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that is widely identified worldwide
The toxigenic isolates detected in both stools samples of patients with C.difficile infection (CDI)
Toxigenic C. difficile strains were divided into four different PCR-ribotypes (012, 014, 017 and IR1) patterns

Summary

Introduction

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. Clostridium difficile, a gram-positive anaerobic bacterium, is the leading cause of pseudomembranous colitis, nosocomial and antimicrobial-associated diarrhea [1, 2]. The pathophysiology of C. difficile involves colonization of Various molecular typing methods have been applied to characterize outbreaks and describe endemic CDI and C. difficile colonization. Hypervirulent clones such as ribotype 027 and to a lesser degree ribotype 078 have been involved in severe nosocomial outbreaks of CDI [3, 4]. Recent MLST studies on C. difficile have focused on human isolates, animal and food strains [6, 7]

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