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Open Access 01-12-2019 | Ulcerative Colitis | Research article

Clostridium difficile isolated from faecal samples in patients with ulcerative colitis

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

Published in: BMC Infectious Diseases | Issue 1/2019

Abstract

Background

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.

Methods

In 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.

Results

The 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).

Conclusion

Overall 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.

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Title: Clostridium difficile isolated from faecal samples in patients with ulcerative colitis
Authors: Parisa Shoaei
Hasan Shojaei
Mohammad Jalali
Farzin Khorvash
Sayed Mohsen Hosseini
Behrooz Ataei
Bahareh Vakili
Fatemeh Ebrahimi
Hossein Tavakoli
Zahra Esfandiari
J. Scott Weese
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Ulcerative Colitis
Chronic Inflammatory Bowel Disease
Metronidazole
Vancomycin
Clostridioides Difficile
Published in: BMC Infectious Diseases / Issue 1/2019
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-019-3965-8

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