Genomic Characterization of Linezolid-Resistant <i>Clostridioides difficile</i> Harboring <i>cfr</i> Variants

The emergence of antimicrobial resistance (AMR) in <i>Clostridium difficile</i> (<i>C. difficile</i>), particularly to last-line antibiotics such as linezolid, represents a critical challenge in clinical settings. This study investigates the genomic epidemiology of linezolid-...

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Main Authors: Aikaterini Panou, Andigoni Malousi, Melina Kachrimanidou
Format: Article
Language:English
Published: MDPI AG 2025-05-01
Series:BioTech
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Online Access:https://www.mdpi.com/2673-6284/14/2/42
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author Aikaterini Panou
Andigoni Malousi
Melina Kachrimanidou
author_facet Aikaterini Panou
Andigoni Malousi
Melina Kachrimanidou
author_sort Aikaterini Panou
collection DOAJ
description The emergence of antimicrobial resistance (AMR) in <i>Clostridium difficile</i> (<i>C. difficile</i>), particularly to last-line antibiotics such as linezolid, represents a critical challenge in clinical settings. This study investigates the genomic epidemiology of linezolid-resistant <i>C. difficile</i>, focusing on the distribution and mutational patterns of the chloramphenicol–florfenicol resistance (<i>cfr</i>) gene and its association with multidrug resistance. We analyzed 514 clinical isolates (354 from NCBI Pathogen Detection, 160 from EnteroBase), revealing distinct prevalence patterns among <i>cfr</i> subtypes: <i>cfr</i>(C) was dominant (156/354 NCBI strains; 101/160 EnteroBase strains), whereas <i>cfr</i>(B) frequently harbored missense mutations (p.R247K, p.V294I, and less commonly p.A334T). The <i>cfr</i>(E) subtype was exclusively identified in ribotype 027 (RT027) strains. Notably, <i>cfr</i>(C) exhibited a strong association with RT017, correlating with a conserved 99 bp genomic deletion. Phylogenetic analysis linked <i>cfr</i>-carriage to predominant sequence types (ST1 in NCBI strains, ST37 in EnteroBase isolates). Furthermore, the co-occurrence of <i>cfr</i> with additional AMR genes conferred resistance to macrolides (erythromycin, azithromycin) and tetracyclines, indicating a convergent evolution toward multidrug resistance. These findings underscore the interplay between <i>cfr</i> mutations, hypervirulent ribotypes, and AMR dissemination, necessitating enhanced surveillance to mitigate the spread of resistant <i>C. difficile</i> lineages.
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spelling doaj-art-071eb8b15fac490d9eacc1c37b7b3fef2025-08-20T03:27:18ZengMDPI AGBioTech2673-62842025-05-011424210.3390/biotech14020042Genomic Characterization of Linezolid-Resistant <i>Clostridioides difficile</i> Harboring <i>cfr</i> VariantsAikaterini Panou0Andigoni Malousi1Melina Kachrimanidou2Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceLaboratory of Biological Chemistry, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceDepartment of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceThe emergence of antimicrobial resistance (AMR) in <i>Clostridium difficile</i> (<i>C. difficile</i>), particularly to last-line antibiotics such as linezolid, represents a critical challenge in clinical settings. This study investigates the genomic epidemiology of linezolid-resistant <i>C. difficile</i>, focusing on the distribution and mutational patterns of the chloramphenicol–florfenicol resistance (<i>cfr</i>) gene and its association with multidrug resistance. We analyzed 514 clinical isolates (354 from NCBI Pathogen Detection, 160 from EnteroBase), revealing distinct prevalence patterns among <i>cfr</i> subtypes: <i>cfr</i>(C) was dominant (156/354 NCBI strains; 101/160 EnteroBase strains), whereas <i>cfr</i>(B) frequently harbored missense mutations (p.R247K, p.V294I, and less commonly p.A334T). The <i>cfr</i>(E) subtype was exclusively identified in ribotype 027 (RT027) strains. Notably, <i>cfr</i>(C) exhibited a strong association with RT017, correlating with a conserved 99 bp genomic deletion. Phylogenetic analysis linked <i>cfr</i>-carriage to predominant sequence types (ST1 in NCBI strains, ST37 in EnteroBase isolates). Furthermore, the co-occurrence of <i>cfr</i> with additional AMR genes conferred resistance to macrolides (erythromycin, azithromycin) and tetracyclines, indicating a convergent evolution toward multidrug resistance. These findings underscore the interplay between <i>cfr</i> mutations, hypervirulent ribotypes, and AMR dissemination, necessitating enhanced surveillance to mitigate the spread of resistant <i>C. difficile</i> lineages.https://www.mdpi.com/2673-6284/14/2/42<i>C. difficile</i><i>Cfr</i> subtypesSTlinezolidantimicrobial resistance genes
spellingShingle Aikaterini Panou
Andigoni Malousi
Melina Kachrimanidou
Genomic Characterization of Linezolid-Resistant <i>Clostridioides difficile</i> Harboring <i>cfr</i> Variants
BioTech
<i>C. difficile</i>
<i>Cfr</i> subtypes
ST
linezolid
antimicrobial resistance genes
title Genomic Characterization of Linezolid-Resistant <i>Clostridioides difficile</i> Harboring <i>cfr</i> Variants
title_full Genomic Characterization of Linezolid-Resistant <i>Clostridioides difficile</i> Harboring <i>cfr</i> Variants
title_fullStr Genomic Characterization of Linezolid-Resistant <i>Clostridioides difficile</i> Harboring <i>cfr</i> Variants
title_full_unstemmed Genomic Characterization of Linezolid-Resistant <i>Clostridioides difficile</i> Harboring <i>cfr</i> Variants
title_short Genomic Characterization of Linezolid-Resistant <i>Clostridioides difficile</i> Harboring <i>cfr</i> Variants
title_sort genomic characterization of linezolid resistant i clostridioides difficile i harboring i cfr i variants
topic <i>C. difficile</i>
<i>Cfr</i> subtypes
ST
linezolid
antimicrobial resistance genes
url https://www.mdpi.com/2673-6284/14/2/42
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AT melinakachrimanidou genomiccharacterizationoflinezolidresistanticlostridioidesdifficileiharboringicfrivariants