Isolation and characterization of a multidrug-resistant Clostridioides difficile toxinotype V from municipal wastewater treatment plant

Akram Baghani; Mahmood Alimohammadi; Amir Aliramezani; Maliheh Talebi; Alireza Mesdaghinia; Masoumeh Douraghi

doi:10.1007/s40201-020-00546-0

Isolation and characterization of a multidrug-resistant Clostridioides difficile toxinotype V from municipal wastewater treatment plant

J Environ Health Sci Eng. 2020 Sep 26;18(2):1281-1288. doi: 10.1007/s40201-020-00546-0. eCollection 2020 Dec.

Authors

Akram Baghani¹, Mahmood Alimohammadi^{2

3}, Amir Aliramezani¹, Maliheh Talebi⁴, Alireza Mesdaghinia^{2

3

5}, Masoumeh Douraghi^{1

2

6}

Affiliations

¹ Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, PO Box: 14155-6446, Tehran, Iran.
² Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.
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 Research (CWQR), Department of Environmental Health Engineering, School of Public Health, Institute for Environmental Research (IER), Tehran University of Medical Sciences, PO Box: 14155-6446, Tehran, Iran.
⁶ Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

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.