Research Article Antimicrobial Resistance and Associated Risk Factors for Clostridium difficile in Patients Attending Tertiary Care Settings Murad A. Mubaraki , 1 Mubbashir Hussain , 2 Faaiz Ul Hassan, 2 Shahzad Munir, 3 Fozia Fozia , 4 Ijaz Ahmad , 5 Fatima Bibi, 2 Samia Sultan, 6 and Ziaullah Zialluh 7 1 Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia 2 Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan 3 Yunnan Agricultural University, Kunming, China 4 Department of Biochemistry, KMU Institute of Dental Sciences, Kohat 26000, Pakistan 5 Department of Chemistry, Kohat University of Science and Technology, Kohat, Pakistan 6 Department of Zoology, Abdul Wali Khan University, Mardan, Pakistan 7 College of Professional Studies, Northeastern University, Boston, MA, USA Correspondence should be addressed to Mubbashir Hussain; mubbashir.hussain@kust.edu.pk and Fozia Fozia; drfoziazeb@yahoo.com Received 29 April 2023; Revised 31 March 2024; Accepted 3 May 2024; Published 16 May 2024 Academic Editor: Amitis Ramezani Copyright©2024MuradA.Mubarakietal.TisisanopenaccessarticledistributedundertheCreativeCommonsAttribution License,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperly cited. Todeterminetheincidenceofantimicrobial•resistantemergingpathogens, Clostridium difcile,anditsassociatedriskfactorsin tertiary care setups of Pakistan. Tis cross•sectional prospective study was conducted from January 2019 to December 2020, to determinetheprevalenceandantimicrobialresistancepatternsof C. difcile strainsisolatedfrom450stoolspecimensofpatients sufering from diarrhea hospitalized in tertiary care hospitals in Peshawar, Pakistan. Te stool samples of the patients were processed for culture and detection of toxin A and toxin B by enzyme•linked immunosorbent assay (ELISA) and tpi PCR. Te drug sensitivity test was performed for antibiotics including ampicillin, cefxime, cefepime, amoxicillin, nalidixic acid, sul• pha/TMP (SXT), chloramphenicol, metronidazole, vancomycin, ciprofoxacin, levofoxacin, and imipenem. Of 450 stool specimens, 108 (24%) were positive for C. difcile by stool culture, whereas 115 (25.5%) were only positive for C. difcile toxins based on ELISA and PCR (128 (28.6%). Of 108, 90.7% (n � 98) isolates were resistant to one antibiotic, and 90 (83.4%) were resistant to three or more antimicrobials. Te highest resistance rates were found against penicillin (83.3%) followed by amoxicillin(70%),nalidixicacid(61%),andmetronidazole(38%),andthelowestresistancewasfoundagainstvancomycin(6.4%) andimipenem(3.7%).CDIwasstatisticallysignifcantlycorrelatedwithincreasedage,useofantibiotics,abdominalsurgeries,use of proton pump inhibitors and H2a, and presence of comorbidities. Te high frequency of C. difcile in Peshawar, Pakistan, indicatesthatCDIisanimportantnosocomialinfectionindiferenthospitals.Teresultswillbehelpfulforclinicianstoredesign control and therapeutic strategies in hospitals. 1. Introduction Clostridium difcile (C. difcile) is an obligate anaerobic, spore•forming bacillus present as a part of gut fora in the intestinal tract of healthy adults and elder subjects. It has recently been renamed as Clostridioides difcile [1]. It is amajorcauseofhospital•associatedenterocolitisresultingin antibiotic•associated diarrhea, pseudomembranous colitis antibiotic•associated colitis, sepsis, and even death. Tese infections are collectively known as Clostridium difcile infections (CDI) [2–4]. C. difcile is a spore•forming bac• teriumthatcansurviveinthehospitalsettingforalongtime and can spread in hospitals through contaminated equip• ment and hospital personnel [5]. CDI spread within hospitals and among communities has made it more challenging than ever. Te increased Hindawi Journal of Tropical Medicine Volume 2024, Article ID 6613120, 8 pages https://doi.org/10.1155/2024/6613120