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Peer-reviewedCC BY-NC-ND 4.0BMC Microbiology

Antibiotic resistance profiles and molecular characteristics of Clostridioides difficile PCR ribotypes in patients with colorectal polyps

  • Taher Azimi1
  • Maryam Asli2
  • Ebrahim Fallahzadeh3
  • Mina Biglari Nejad4
  • Sahar Sabour5
  • Neda Mohagheghzadeh1
  • Saeed Soleiman Meigooni6,7
  • Shiva Nazari8
8 affiliations
  1. 1Department of Bacteriology & Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
  2. 2Department of Infectious Diseases, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
  3. 3Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  4. 4Undergraduate Student, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
  5. 5Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  6. 6Infectious Diseases Research Centre, Aja University of Medical Sciences, Tehran, Iran
  7. 7Clinical Research Development Unit, Khanevadeh Hospital, Aja University of Medical Sciences, Tehran, Iran
  8. 8Pediatric Congenital Hematologic Disorders Research Center, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract

Background: The present study aimed to survey the antibiotic resistance patterns and toxin gene expression levels in different PCR ribotypes and sequency types of C.difficile isolated from patients with colorectal polyps.

Methods: A total of 305 stool specimens were collected from patients with colorectal polyps. The antimicrobial susceptibility of C. difficile isolates was determined using the Liofilchem® MIC Test Strips and disk diffusion method (DDM). The prevalence of toxin-encoding genes (tcdA, tcdB, cdtA, cdtB) was determined by PCR assay. PCR ribotyping was performed on all C. difficile isolates that tested positive for at least one of the toxin-encoding genes. SYBR Green based qRT-PCR was employed to determine the relative expression of toxin-encoding genes in C. difficile Ribotypes (RTs). Multilocus sequence typing (MLST) analysis was performed to investigate the genetic relationships of the C. difficile RTs.

Results: A total of 37 C. difficile isolates were isolated from 305 stool samples (12.1%). Overall, 35.1% (n = 13/37), 48.6% (n = 18/37), 35.1% (n = 13/37), and 43.2% (n = 16/37) of C. difficile isolates were positive for tcdA, tcdB, cdtA, and cdtB genes, respectively. Out of 23 toxin gene-positive C. difficile isolates, 8 isolates were tcdA-/tcdB+/cdtA+/cdtB+, 5 isolates were tcdA+/tcdB+/cdtA+/cdtB-, and 4 isolates were tcdA+/tcdB-/cdtA-/cdtB+. The most prevalent RTs among C. difficile isolates were 012 (34.78%; n = 8), 126 (21.73%; n = 5), and 001 (17.39%; n = 4). The most frquenctly detected sequence types were ST-2 (n = 9; 39.13%), followed by ST-54 (n = 6; 26%). Toxigenic C. difficile isolates showed the lowest resistance rate to vancomycin (8.7%; n = 2/23) and metronidazole (13%; n = 3/20), respectively. The rates of vancomycin resistance in RT001 (25%) and RT126 (20%) C. difficile isolates were higher than those in other RTs. tcdB gene expression was significantly high in RT027 (8.15 fold), and RT078 (6.25 fold). Meanwhile, the tcdA relative expression level was significantly high in RT027 (6.25 fold), RT078 (4.75 fold) and RT126 (4.35 fold).

Conclusion: The significant increase in toxin gene expression observed in RT012, in addition to the hypervirulent ribotypes RT027 and RT078, is particularly concerning and highlights the potential for RT012 to become an emerging clinical challenge.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12866-026-05336-6.

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Cite

BibTeXRIS
BibTeX
@article{azimi2026antibiotic,
  title = {{Antibiotic resistance profiles and molecular characteristics of Clostridioides difficile PCR ribotypes in patients with colorectal polyps}},
  author = {Taher Azimi and Maryam Asli and Ebrahim Fallahzadeh and Mina Biglari Nejad and Sahar Sabour and Neda Mohagheghzadeh and Saeed Soleiman Meigooni and Shiva Nazari},
  journal = {BMC Microbiology},
  year = {2026},
  month = jul,
  doi = {10.1186/s12866-026-05336-6},
  url = {https://doi.org/10.1186/s12866-026-05336-6},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Antibiotic resistance profiles and molecular characteristics of Clostridioides difficile PCR ribotypes in patients with colorectal polyps
AU  - Taher Azimi
AU  - Maryam Asli
AU  - Ebrahim Fallahzadeh
AU  - Mina Biglari Nejad
AU  - Sahar Sabour
AU  - Neda Mohagheghzadeh
AU  - Saeed Soleiman Meigooni
AU  - Shiva Nazari
PY  - 2026
DA  - 2026/07/31
JO  - BMC Microbiology
DO  - 10.1186/s12866-026-05336-6
UR  - https://doi.org/10.1186/s12866-026-05336-6
AB  - Background: The present study aimed to survey the antibiotic resistance patterns and toxin gene expression levels in different PCR ribotypes and sequency types of C.difficile isolated from patients with colorectal polyps.  Methods: A total of 305 stool specimens were collected from patients with colorectal polyps. The antimicrobial susceptibility of C. difficile isolates was determined using the Liofilchem® MIC Test Strips and disk diffusion method (DDM). The prevalence of toxin-encoding genes (tcdA, tcdB, cdtA, cdtB) was determined by PCR assay. PCR ribotyping was performed on all C. difficile isolates that tested positive for at least one of the toxin-encoding genes. SYBR Green based qRT-PCR was employed to determine the relative expression of toxin-encoding genes in C. difficile Ribotypes (RTs). Multilocus sequence typing (MLST) analysis was performed to investigate the genetic relationships of the C. difficile RTs.  Results: A total of 37 C. difficile isolates were isolated from 305 stool samples (12.1%). Overall, 35.1% (n = 13/37), 48.6% (n = 18/37), 35.1% (n = 13/37), and 43.2% (n = 16/37) of C. difficile isolates were positive for tcdA, tcdB, cdtA, and cdtB genes, respectively. Out of 23 toxin gene-positive C. difficile isolates, 8 isolates were tcdA-/tcdB+/cdtA+/cdtB+, 5 isolates were tcdA+/tcdB+/cdtA+/cdtB-, and 4 isolates were tcdA+/tcdB-/cdtA-/cdtB+. The most prevalent RTs among C. difficile isolates were 012 (34.78%; n = 8), 126 (21.73%; n = 5), and 001 (17.39%; n = 4). The most frquenctly detected sequence types were ST-2 (n = 9; 39.13%), followed by ST-54 (n = 6; 26%). Toxigenic C. difficile isolates showed the lowest resistance rate to vancomycin (8.7%; n = 2/23) and metronidazole (13%; n = 3/20), respectively. The rates of vancomycin resistance in RT001 (25%) and RT126 (20%) C. difficile isolates were higher than those in other RTs. tcdB gene expression was significantly high in RT027 (8.15 fold), and RT078 (6.25 fold). Meanwhile, the tcdA relative expression level was significantly high in RT027 (6.25 fold), RT078 (4.75 fold) and RT126 (4.35 fold).  Conclusion: The significant increase in toxin gene expression observed in RT012, in addition to the hypervirulent ribotypes RT027 and RT078, is particularly concerning and highlights the potential for RT012 to become an emerging clinical challenge.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12866-026-05336-6.
SN  - 1471-2180
ER  -