Molecular Characterization and Antimicrobial Susceptibility of Clostridioides difficile Isolates in Patients with Inflammatory Bowel Disease in Gorgan, Iran

This study investigated the molecular characteristics and antibiotic susceptibility patterns of Clostridioides difficile strains from Iranian inflammatory bowel disease (IBD) patients due to their vulnerability to Clostridioides difficile infection (CDI). Fecal samples from 155 IBD patients were analyzed for C. difficile toxins A/B and cultured for toxigenic strains. Antimicrobial susceptibility of isolates to five drugs was determined using E-test. Toxigenic strains underwent CE-ribotyping for further characterization. 11 C. difficile isolates showed varying resistance rates to vancomycin (27.27%), metronidazole (36.3%), moxifloxacin (45.4%), clindamycin (63.6%), and tetracycline (54.5%). 8 toxigenic isolates had toxin gene profiles: A + B + (62.5%), A + B + CDT + (25%), and A – B + (12.5%). CDI occurrence was linked to immunosuppressant, adalimumab, and PPI use (P = 0.038). The most frequent ribotypes were RT 002, RT 126, and RT 014. Iranian IBD patients have diverse C. difficile genotypes with varying antimicrobial resistance. Those experiencing flare-ups and receiving anti-TNF drugs with other medications may face increased CDI risk, emphasizing the need for early testing and treatment in developing countries. Further research should explore clinical implications of CDI in IBD patients.