Paper Title
Prevalence, Antibiogram, Phenotypic and Genotypic Analysis of Clostridioides (Clostridium) Difficiletoxigenic Strains from Stool Samples at King Saud Medical City

Abstract
Clostridioides difficile is a gram-positive, anaerobic, spore-forming, considered one of the major causes of nosocomial infection; c.difficile infection (CDI) is one of the major causes of nosocomial infection and global threat.Aim: To detect the clostridioides difficile in the KSMC in Riyadh. The second objective was to determine the Phenotypic and genotypic analysis of the isolated toxigenic c.difficile and investigate the antimicrobial susceptibility patterns of toxigenic c.difficileisolates.Materials and Methods: From January 2021 to December 2021, 313 stool samples were collected from KSMC hospitals in the capital of KSA and screened for the presence of c.difficile. Each sample was cultured on c.difficile Selective Agar and incubated in anaerobic conditions at 37°C for 48-72 hours. The sample was then tested phenotypically for toxin A&B to detect the toxigenic from nontoxigenic by commercial kit ImmunoCard Toxins A & B, Meridian Bioscience. The antimicrobial susceptibility was done using the brucella modified Blood agar and the E test. The molecular test result was imported from the real-time PCR technique through GeneXpert from the Cepheid company.Result: CDI with detected in KSMC in Riyadh at 9.3%, whereas the non-toxigenic 1.6%, the antimicrobial susceptibility of the 28 strains revealed that 100% were sensitive to the vancomycin and metronidazole agents. the moxifloxacin and tetracycline show 89.3%,82.1% respectively. Keywords - Clostridioidesdifficile,Toxigenicc. Difficile, Antibiogram, CDI, prevalence, Riyadh