Phenotypic and Genotypic Characteristics of Clostridium difficile Isolates in Patients with Type 2 Diabetes in Iran

Figures & data

Table 1 Clinical Features of 104 Hospitalized Patients with Type 2 Diabetes in Toxigenic C. difficile Strains, Negative C. difficile Strains and Non-Toxigenic C. difficile Strains Groups Admitted to the 4 University Hospitals, Isfahan, Iran (2015–2017)

Variables	CDI, n (%)	Non-CDI, n (%)		Univariate Analysis P value
	Toxigenic C. difficile Isolates, (tcdA^+tcdB^+), n = 13	Negative C. difficile Strains, n = 83	Non Toxigenic Strains (tpi^+), n=8
Age, mean (SD)	50.8 (13.3)	52.3 (14.4)	51.6 (14.3)	0.75
BMI (kg/m^2) mean (SD)	26.8 (4.1)	26.1 (5.1)	27.2 (7.4)	0.87
Male gender	7(53.8)	34(40.9)	3(37.5)	0.08
Laboratory values
White blood cell(10^9/L) median (IQR)^a	12.2(9.1–19.2)	10.8(8.7–18.0)	11.5(8.9–18.7)	0.93
Albumin(g/dL)	2.3(2.0–2.4)	2.4(1.96–2.6)	2.1(1.89–2.3)	0.98
Creatinine(mg/dL)	1.2(0.6–1.40)	0.98(0.5–1.21)	1.1(0.6–1.32)	0.86
Symptom
Fever	8(61.5)	48(57.8)	4(50)	0.89
Abdominal pain	5(38.4)	33(39.7)	3(37.5)	0.91
Abdominal cramp	3(23.1)	17(20.5)	2(25)	0.61
Complications of diabetes mellitus
Renal failure	3(23.1)	16(19.3)	0	0.09
Hypertension	7(53.8)	53(62.6)	3(37.5)	0.12
Sepsis	1(7.7)	7 (8.4)	0	0.10
Heart failure	5(38.5)	17(20.5)	1(25.0)	0.008
Infected diabetic foot	2(15.4)	14(16.9)	1 (12.5)	0.11
Respiratory failure	1(7.7)	4(4.8)	0	0.14
Gastroenteritis disease	2(15.4)	19(22.9)	1(12.5)	0.16
Prior hospitalization (within 1 mo^b)	9(69.2)	23(27.7)	2(25)	<0.001
Medication use within 8 weeks prior to CDI test
Penicillin	7(53.8)	34(40.1)	3(37.5)	0.08
Ciprofloxacin	5(38.5)	29(34.9)	2(25)	0.10
Carbapenem	3(23.1)	11(13.3)	0	0.005
Cephalosporin	9(69.2)	43(51.8)	2(25)	<0.001
Fluoroquinolone	4(30.8)	21(25.3)	1(12.5)	0.20
Metronidazole	0	6(7.2)	0	0.18
Clindamycin	2(15.4)	15(18.1)	1(12.5)	0.78
Insulin	6(46.1)	32(38.5)	3(37.5)	0.006
Metformin	5(38.5)	57(68. 7)	5(62.5)	0.009

Note: ^aInterquartile range. ^bHospitalization within one month prior to the study.

Abbreviations: CDI, C. difficile infection; SD, standard deviation.

Table 2 Antimicrobial Susceptibility Testing of 21 Isolates to 6 Antimicrobial Agents

Agent	MIC (µg/mL)			No. (%) Isolates Toxigenic C. difficile (n = 13)			No. (%) Isolates Non Toxigenic Strains (n = 8)			MIC Breakpoints (S/I/R) (S/R)
	Range	50%	90%	S	I	R	S	I	R
Clindamycin^a	2 −256	16	256	4 (30.8)	2 (15.4)	7 (53.8)	2 (25)	2 (25)	4(50)	≤ 2/4/8 ≥
Metronidazole^b	0.0.32- 2	0.25	0.5	13 (100)	0	0	8 (100)	0	0	≥ 2^b
Rifampicin^a	0.032-34	0.016	0.016	12 (92.3)	0	1 (7.7)	8(100)	0	0	≤ 8/16/32 ≥
Moxifloxacin^a	3 −32	2	> 32	8 (61.5)	0	5 (38.5)	6 (75)	0	2 (25)	≤4/>4^b
Vancomycin^b	0.016–1.5	0.032	0.032	13(100)	0	0	8(100)	0	0	≥ 2^b
Fusidic acid^a	0.016 −2	0.016	0.016	12 (92.3)	0	1 (7.7)	8 (100)	0	0	<1/>1^b

Notes: ^aMIC breakpoints applied were those recommended for anaerobes by the Clinical and Laboratory Standards Institute (CLSI).²² The breakpoints are based on epidemiological cut-off values (ECOFFs). ^bVancomycin and metronidazole MIC breakpoints were recommended by the European Committee on Antimicrobial Susceptibility Testing (http://www.eucast.org.).²¹

Abbreviations: i, intermediate; s, susceptible; r, resistant.

Figure 1 Dendrogram of the detected isolates of C. difficile, RAPD-PCR DNA fingerprints with the primer AP4. Dendrogram is color coded according to sequence types (STs) and toxin types.

Wayne P. Performance Standards for Antimicrobial Susceptibility Testing. Clinical and laboratory standards institute; 2011.

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Testing ECoAS. Breakpoint tables for interpretation of MICs and zone diameters. Version 9.0, valid from 2019-01-01.

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