Toxin genotypes, antibiotic resistance and their correlations in Clostridioides difficile isolated from hospitals in Xi'an, China

BMC Microbiol. 2024 May 23;24(1):177. doi: 10.1186/s12866-024-03327-z.

Abstract

Background: Clostridioides difficile is the main pathogen of antimicrobial-associated diarrhoea and health care facility-associated infectious diarrhoea. This study aimed to investigate the prevalence, toxin genotypes, and antibiotic resistance of C. difficile among hospitalized patients in Xi'an, China.

Results: We isolated and cultured 156 strains of C. difficile, representing 12.67% of the 1231 inpatient stool samples collected. Among the isolates, tcdA + B + strains were predominant, accounting for 78.2% (122/156), followed by 27 tcdA-B + strains (27/156, 17.3%) and 6 binary toxin gene-positive strains. The positive rates of three regulatory genes, tcdC, tcdR, and tcdE, were 89.1% (139/156), 96.8% (151/156), and 100%, respectively. All isolates were sensitive to metronidazole, and the resistance rates to clindamycin and cephalosporins were also high. Six strains were found to be resistant to vancomycin.

Conclusion: Currently, the prevalence rate of C. difficile infection (CDI) in Xi'an is 12.67% (156/1231), with the major toxin genotype of the isolates being tcdA + tcdB + cdtA-/B-. Metronidazole and vancomycin were still effective drugs for the treatment of CDI, but we should pay attention to antibiotic management and epidemiological surveillance of CDI.

Keywords: Clostridioides difficile; Antibiotic resistance; Toxin gene expression; Toxin genes.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents* / pharmacology
  • Bacterial Proteins / genetics
  • Bacterial Toxins* / genetics
  • China / epidemiology
  • Clindamycin / pharmacology
  • Clostridioides difficile* / classification
  • Clostridioides difficile* / drug effects
  • Clostridioides difficile* / genetics
  • Clostridioides difficile* / isolation & purification
  • Clostridium Infections* / epidemiology
  • Clostridium Infections* / microbiology
  • Diarrhea / epidemiology
  • Diarrhea / microbiology
  • Drug Resistance, Bacterial / genetics
  • Enterotoxins / genetics
  • Feces* / microbiology
  • Female
  • Genotype*
  • Hospitals* / statistics & numerical data
  • Humans
  • Male
  • Metronidazole / pharmacology
  • Microbial Sensitivity Tests
  • Middle Aged
  • Prevalence
  • Vancomycin / pharmacology
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Bacterial Toxins
  • Bacterial Proteins
  • Metronidazole
  • Enterotoxins
  • Vancomycin
  • Clindamycin