This study represents the first analysis from Iran for both the frequency of the most common causes of infectious diarrhoea and their antibiotic resistance patterns in adult patients. Adult stool specimens ( = 211) were analyzed. Stool specimens were analyzed using standard microbiological, polymerase chain reaction, and reverse transcription polymerase chain reaction tests to identify bacterial, parasitic, and viral enteropathogens. Antibiotic resistance profiles were determined. Enteropathogens were identified in 46.4% (98/211) of the surveyed samples. This included 33.1% (70/211) bacterial infections, including 9.9% (21/211) diarrheagenic (DEC) and 8.5% (18/211) spp. We detected 7.1% (15/211) parasitic infections (mostly ) and 6.1% (13/211) viral infections (mostly adenovirus). The DEC and spp. isolates included many multi-drug resistant (MDR) isolates (95.2% and 77.7%, respectively), and extended spectrum-β-lactamase (ESBL) genes were often present (57.1% and 61.1%, respectively). The most commonly identified ESBL genes in the DEC and spp. isolates were (100% in both species), (91.6% and 100%, respectively), AmpC (80% and 100%, respectively), and (80% and 100%, respectively). Bacterial infection was the primary cause of infectious diarrhea, affecting one-third of the adults. The frequency of DEC and spp. was higher than for other enteropathogens. The high prevalence of MDR, the elevated incidence of ESBL genes among spp. and DEC isolates, and the presence of quinolone resistance in the spp. isolates represent a significant challenge for gastroenteritis diagnosis and treatment in this region.
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