Abstract

Clostridioides infection (CDI) remains a major healthcare problem worldwide, however, little is known about CDI epidemiology in Iran. Between December 2004 and November 2018, 3649 stool samples were collected from patients in 69 hospitals and medical centres in Tehran and were cultured for the presence of C. difficile; isolates were characterised by PCR ribotyping and toxin genes detection. A total of 582 C. difficile isolates were obtained and the overall CDI prevalence was 15.9%; 290 (49.8%) cases were healthcare-associated (HA) and 292 (50.2%) cases were community-associated (CA). Of these, DNA of 513 isolates submitted for ribotyping. The ribotype and/or WEBRIBO type could be assessed in 366 (62.9%) isolates. The most frequent RTs were 001 (n=75, 12.9%), 126 (n=65, 11.2%) and 084 (n=19, 3.3%); the toxin gene profile tcdA ⁺ B ⁺ /cdtA ⁺ B ⁺ (n=112, 19.2%) was the most common. Fifteen C. difficile isolates (2.6%) did not carry any toxin genes. There was no difference between frequently found RTs in HA-CDI and CA-CDI, except for RT 029 which was more likely to be associated with healthcare origin (12/15, p-value=0.02). No isolate of RTs 027 or 078 was identified. Importantly, RTs 031, 038, 039, 084, 085 reported previously as RTs with an absence of toxin genes, revealed the presence of toxin genes in our study. Using Simpson’s reciprocal index of diversity, we found that RT diversity decreased as the prevalence of the RT 084 increased (R= -0.78, p-value=0.041). Different patterns in CDI epidemiology underscore the importance of local surveillance and infection control measures in Tehran healthcare settings.

摘要

梭状芽胞杆菌感染（CDI）仍然是世界范围内的主要医疗保健问题，但是，伊朗对CDI流行病学知之甚少。在2004年12月至2018年11月之间，从德黑兰的69家医院和医疗中心的患者中收集了3649份粪便样品，并进行了培养以检测艰难梭菌的存在; 通过PCR核糖分型和毒素基因检测来鉴定分离株。总共582个艰难梭菌获得了分离株，总CDI患病率为15.9％；卫生保健相关（HA）290例（49.8％），社区相关（CA）292例（50.2％）。其中，有513个分离物的DNA提交了核糖分型。可以在366（62.9％）个分离物中评估核糖型和/或WEBRIBO型。最常见的RT是001（n = 75，12.9％），126（n = 65，11.2％）和084（n = 19，3.3％）; 毒素基因图谱tcdA ⁺ B ⁺ / cdtA ⁺ B ⁺（n = 112，19.2％）是最常见的。十五个艰难梭菌分离株（2.6％）没有携带任何毒素基因。在HA-CDI和CA-CDI中，经常发现的RT之间没有差异，除了RT 029更可能与医疗保健起源相关（12/15，p值= 0.02）。未鉴定出RT 027或078的分离物。重要的是，RTs 031，038，039，084，085以前被报道为不包含毒素基因的RTs，在我们的研究中揭示了毒素基因的存在。使用辛普森的倒数多样性指数，我们发现RT多样性随着RT 084的患病率增加而降低（R = -0.78，p值= 0.041）。CDI流行病学的不同模式强调了德黑兰医疗机构中本地监视和感染控制措施的重要性。