Clostridium difficile infection in cancer patients with hospital acquired diarrhea at the teaching hospitals in Iran: Multilocus sequence typing analysis (MLST) and Antimicrobial resistance pattern

Abstract

Background. This study aimed to investigate the phenotype and genotype characterization of Clostridium difficile isolates among cancer patients with hospital-acquired diarrhea in 4 teaching hospitals in Isfahan, Iran. Study design. This was a cross sectional study conducted on adult (>18 years old) between April 2015 and May 2017. Methods. Over two years, 67 diarrheic fecal samples were collected. C. difficile isolates were characterized according to the presence of toxin genes and antibiotic resistance. Multilocus sequence typing (MLST) was performed to evaluate the genetic relationships between different lineages of toxigenic strains. Results. Seven toxigenic and 12 non- toxigenic strains were detected among stool samples. Patients with a history of previous surgery during hospitalization were more than 7 times likely to develop Clostridium difficile infection (CDI). All isolates were susceptible to metronidazole, vancomycin and fusidic acid. Toxigenic C. difficile strains were divided into 3 different sequence types. The detected types were ST-54, ST-2 and ST-37, while none of the isolates was identified as ST-1 or ST-11. Conclusions. This is the first description of the MLST analysis of C. difficile strains isolated from cancer patients in Iran. All of the studied population were exposed to multiple antibiotics and chemotherapeutic agents. Further research and clinical studies are recommended in the treatment through good antimicrobial stewardship and prevention of C. difficile infection in all healthcare settings.