AUTHOR=Aguilar-Zamora Emmanuel , Weimer Bart C. , Torres Roberto C. , Gómez-Delgado Alejandro , Ortiz-Olvera Nayeli , Aparicio-Ozores Gerardo , Barbero-Becerra Varenka J. , Torres Javier , Camorlinga-Ponce Margarita 

TITLE=Molecular Epidemiology and Antimicrobial Resistance of Clostridioides difficile in Hospitalized Patients From Mexico

JOURNAL=Frontiers in Microbiology

VOLUME=12

YEAR=2022

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2021.787451

DOI=10.3389/fmicb.2021.787451

ISSN=1664-302X

ABSTRACT=<p><italic>Clostridioides difficile</italic> is a global public health problem, which is a primary cause of antibiotic-associated diarrhea in humans. The emergence of hypervirulent and antibiotic-resistant strains is associated with the increased incidence and severity of the disease. There are limited studies on genomic characterization of <italic>C. difficile</italic> in Latin America. We aimed to learn about the molecular epidemiology and antimicrobial resistance in <italic>C. difficile</italic> strains from adults and children in hospitals of México. We studied 94 <italic>C. difficile</italic> isolates from seven hospitals in Mexico City from 2014 to 2018. Whole-genome sequencing (WGS) was used to determine the genotype and examine the toxigenic profiles. Susceptibility to antibiotics was determined by <italic>E</italic>-test. Multilocus sequence typing (MLST) was used to determine allelic profiles. Results identified 20 different sequence types (ST) in the 94 isolates, mostly clade 2 and clade 1. ST1 was predominant in isolates from adult and children. Toxigenic strains comprised 87.2% of the isolates that were combinations of <italic>tcdAB</italic> and <italic>cdtAB</italic> (<italic>tcdA+/tcdB+/cdtA+/cdtB+</italic>, followed by <italic>tcdA+/tcdB+/cdtA−/cdtB−</italic>, <italic>tcdA</italic>−/<italic>tcdB+/cdtA−/ cdtB−</italic>, and <italic>tcdA−</italic>/<italic>tcdB−/cdtA+/cdtB+</italic>). Toxin profiles were more diverse in isolates from children. All 94 isolates were susceptible to metronidazole and vancomycin, whereas a considerable number of isolates were resistant to clindamycin, fluroquinolones, rifampicin, meropenem, and linezolid. Multidrug-resistant isolates (≥3 antibiotics) comprised 65% of the isolates. The correlation between resistant genotypes and phenotypes was evaluated by the kappa test. Mutations in <italic>rpoB</italic> and <italic>rpoC</italic> showed moderate concordance with resistance to rifampicin and mutations in <italic>fusA</italic> substantial concordance with fusidic acid resistance. <italic>cfrE</italic>, a gene recently described in one Mexican isolate, was present in 65% of strains linezolid resistant, all ST1 organisms. WGS is a powerful tool to genotype and characterize virulence and antibiotic susceptibility patterns.</p>