Majid Ezatkhah - Department of Research and Technology, Kerman branch, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Kerman, Iran
Mojtaba Alimolaei - Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
Hamid-Reza Rahimi - Department of Toxicology and Pharmacology, School of Pharmacy, Kerman University of Medical Sciences
Mehrdad Shamsaddini Bafti - Kerman branch, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Kerman, Iran
Sadegh Afzali - Department of Research and Technology, Kerman branch, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Kerman, Iran

Introduction and Objectives: Clostridium difficile (C. difficile), an anaerobic, spore forming bacillus remains the leading cause of nosocomial-acquired diarrhea that known as C. difficile infection (CDI). This study investigated the prevalence and antimicrobial resistance patterns of C. difficile isolated from hospitalized patients and patients seen as outpatients suffering from diarrhoea in Kerman, Iran, over a 2-year (2016 to 2018). Materials and Methods: A total of 151 stool specimens were collected and screened for the presence of C. difficile and discovered its toxins by culture, enzyme immunoassay (EIA), and PCR methods. Moreover, the confirmed C. difficile isolates were tested against twelve antibiotics (metronidazole, vancomycin, clindamycin, tetracycline, erythromycin, ciprofloxacin, levofloxacin, moxifloxacin, fusidic acid, piperacillin, piperacillin/tazobactam and rifampicin) by disk diffusion method, according to the CLSI, EUCAST, and CA-SFM guidelines. Results: Out of 151 patients, 66 (43.71%) cases were positive for C. difficile by PCR. Two (1.32%) patients were only positive for C. difficile toxins based on EIA. A total of 292 clostridial isolates were obtained from specimens by culture, where 133 (45.55%) isolates finally confirmed as C. difficile by PCR. One hundred and seven (88.43%) isolates were resistant to at least three antibiotics and defined as multidrug resistant strains. Different and diverse resistant patterns to the antimicrobial drugs were seen among the isolates. Conclusions: This is the first report of the isolation of C. difficile from Kerman hospitals. Results indicate that CDI might be an important nosocomial infection in different hospital wards. Moreover, this study provides a good comprehensive picture of the MDR phenotype characteristics of C. difficile isolates in Iran.

Clostridium difficile; Prevalence; Antimicrobial Resistance; Kerman; EIA; PCR