Isolation and characterization of a multidrug-resistant Clostridioides difficile toxinotype V from municipal wastewater
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RESEARCH ARTICLE
Isolation and characterization of a multidrug-resistant Clostridioides difficile toxinotype V from municipal wastewater treatment plant Akram Baghani 1 & Mahmood Alimohammadi 2,3 & Amir Aliramezani 1 & Maliheh Talebi 4 & Alireza Mesdaghinia 2,3,5 & Masoumeh Douraghi 1,2,6 Received: 23 January 2020 / Revised: 7 September 2020 / Accepted: 21 September 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose Wastewater treatment plant (WWTP) is regarded as a potential source for transmission of Clostridioides difficile from urban areas into the surface water, through feces of human and animals. The aim of this study was to screen and characterize the C. difficile bacteria in inlet and outlet wastewater of different WWTPs in Tehran, Iran. Methods Totally, 72 samples were collected from three different WWTPs (inlet site and outlet sites) during a year. C. difficile was isolated and characterized in terms of toxins, toxinotype, resistance profile and genes, and colonization factors using PCR. Results One C. difficile toxinotype V was isolated from the outlet samples. The isolate was susceptible to vancomycin but resistant to metronidazole, tetracycline, ciprofloxacin, and moxifloxacin using MIC Test Strips. The isolated C. difficile was toxigenic (tcdA, tcdB, cdtA, cdtB positive and CPE positive) and had tcdC-A genotype. No mutations were found in fliC and fliD. The slpA sequence type was 078 − 01. The C. difficile was positive for tetM, int, but negative for vanA, nim, and tndX genes. Mutations were not observed in gyrA and gyrB genes. Conclusions This study provided evidence of presence of a multidrug-resistant C. difficile toxinotype V in one of the municipal WWTP. The transmission of such isolate to the environment and reuse of treated wastewater by human pose a threat to human health and dissemination of antibiotic resistant bacteria which are untreatable. Keywords Clostridioides difficile . Multidrug-resistance . Toxinotype V . Wastewater treatment plant
Introduction Clostridioides difficile is a cause of hospital-associated C. difficile infection (HA-CDI) or community- associated C. difficile infection (CA-CDI). In recent years, more than 25% of CDI cases have been attributed to the community
source [1]. CA-CDI is diagnosed in individuals without any risk factors for CDI and contact with health care settings. In addition to asymptomatic carriers, environment, animals, and food are implicated in transmission of CA-CDI to human [2]. Wastewater treatment plant (WWTP) is regarded as an important potential source for transmission of enteric pathogens
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40201-020-00546-0) contains supplementary material, which is available to authorized users. *
3
Department of Environmental Health Engineering, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
4
Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
5
Center for Water Quality Re
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