Expression of virulence factors of Clostridioides difficile at sub-minimum inhibitory concentration of antibiotics: A review

Hamid Hakimi; Shokrollah Assar; Mitra Abbasifard; Seyed-Mehdi Mousavi; Reza Bahramabadi; Mohammad Taheri; Siavash Assar; Hasan Ebrahimi Shahmabadi; Ebrahim Rezazadeh Zarandi

doi:10.53730/ijhs.v6nS10.13883

Authors

Hamid Hakimi Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran|Department of Microbiology, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Shokrollah Assar Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran|Department of Microbiology, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Mitra Abbasifard Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran|Department of Internal Medicine, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Seyed-Mehdi Mousavi Department of Microbiology, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Reza Bahramabadi Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran|Department of Microbiology, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Mohammad Taheri Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
Siavash Assar Department of Anesthesiology, Medical School, Kerman University of Medical Sciences, Kerman, Iran
Hasan Ebrahimi Shahmabadi Department of Microbiology, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Ebrahim Rezazadeh Zarandi
erezazadehzarandi50@gmail.com
Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran|Department of Microbiology, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

Keywords:

virulence factors, sub-MIC, clostridioides difficile, antibiotics, gene expression

Abstract

Clostridioides difficile (C. difficile) generally colonizes in the colon of hospitalized patients who receive antibiotics for a long time. C. difficile expresses its virulence factors which are associated with pathogenesis. Naturally, the expression of these virulence factors may be influenced by antibiotics. The effect of antibiotics at the sub-minimum inhibitory concentration (MIC) on virulence factors has been investigated and it is varied and depends on the type of antibiotic and C. difficile isolate. Some of the antibiotics at sub-MIC upregulate virulence factors, while others downregulate. Meanwhile, some antibiotics have no detectable effects on the regulation of virulence factors. Nearly, all investigations have surveyed a few numbers of C. difficile isolates in terms the expression of virulence factors at sub-MIC. Most of the antibiotics at sub-MICs regulate gene expression of virulence factors, toxin production, spore formation, and germination by several mechanisms especially the SOS response system. However, to achieve a clear understanding of the effect of antibiotics at sub-MIC on the expression of genes of virulence factors, which are related to the pathogenesis of C. difficile, further and wider investigations are needed, especially on the issue of the numbers of isolates that have been discussed in the present review article.

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