Molecular Epidemiology of Clostridioides difficile Infections in Patients Hospitalized in 2017-2019 at the Central Teaching Hospital of Medical University of Lodz, Central Poland.

Background/Objectives:Clostridioides difficile infection (CDI) represents a significant public health challenge globally, driven by its increasing prevalence, hypervirulent strains like ribotype 027 (RT027), and growing antibiotic resistance. This study aimed to evaluate the prevalence of RT027 and analyze molecular markers of vancomycin and metronidazole resistance in stool samples from CDI patients hospitalized in Poland between 2017 and 2019. Methods: A total of 200 stool samples from confirmed CDI cases were analyzed for the presence of RT027, vanA (vancomycin resistance), and nim (metronidazole resistance) genes. DNA was extracted, and a polymerase chain reaction (PCR) was conducted using specific primers. Statistical associations between RT027 and resistance genes were evaluated using chi-square tests and logistic regression. Results: RT027 was detected in 14% of samples. The vanA gene, indicative of vancomycin resistance, was found in 52.5% of samples, while the nim gene, associated with metronidazole resistance, was present in 1.5% of cases. Co-occurrence of RT027 with vanA was not statistically significant. The study revealed no significant association between RT027 and vanA. Also, no significant association was observed between RT027 and nim due to the latter's low prevalence. Conclusions: This study highlights a concerning prevalence of vanA among CDI cases, indicating widespread vancomycin resistance and challenging current treatment guidelines. While RT027 prevalence was moderate, no significant associations with vancomycin or metronidazole resistance were observed. These findings emphasize the need for molecular surveillance and improved antimicrobial stewardship to manage CDI effectively.