{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T10:05:19Z","timestamp":1773396319415,"version":"3.50.1"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"1","funder":[{"name":"EIP","award":["NU50CK000490-05-11"],"award-info":[{"award-number":["NU50CK000490-05-11"]}]},{"name":"EIP","award":["NU50CK000508-05-00"],"award-info":[{"award-number":["NU50CK000508-05-00"]}]},{"DOI":"10.13039\/100006520","name":"ELC","doi-asserted-by":"publisher","award":["NU50CK000508-05-00"],"award-info":[{"award-number":["NU50CK000508-05-00"]}],"id":[{"id":"10.13039\/100006520","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The frequent temporal recurrence of Clostridioides difficile infection (CDI) may be the result of relapse with the same strain or reinfection with a different strain. We used whole-genome sequencing (WGS) to assess the genetic diversity and molecular evolution of strains that caused recurrent or sequential CDI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from active population- and laboratory-based surveillance of CDI in Minnesota, USA. We performed WGS on isolates collected from 306 patients with multiple CDI events during 2019\u20132021. We identified multi-locus sequence types (MLSTs), nucleotide variants, and putative mobile genetic elements (MGEs) from WGS data to study the genetic similarity and evolution of those C. difficile genomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among patients with multiple CDI events in the surveillance period, 198 (64.7%) had multiple infections of the same MLST, including 49.6% of patients with subsequent infections beyond the 8-week limit of the case definition for recurrent CDI Among 232 temporally defined events of recurrent CDI, 155 (66.8%) involved isolates of the same MLST. There were no statistically significant correlations between accumulated mutations and elapsed time between same-MLST CDI events. Analysis of sequential same-MLST C. difficile genomes showed evidence of gain or loss of putative mobile genetic elements (MGEs) in 45.6% of genome pairs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Leveraging the largest CDI genomic dataset to date, our results confirm prior findings that recurrent CDI is a combination of reinfection and\/or change in the ascendant strain in mixed infection, and relapse, while expanding knowledge on the evolution of pathogenic C. difficile strains in the human gastrointestinal tract.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiaf505","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T12:21:43Z","timestamp":1759234903000},"page":"e44-e54","source":"Crossref","is-referenced-by-count":0,"title":["Insights on Recurrent and Sequential\n                    <i>Clostridioides difficile<\/i>\n                    Infections From Genomic Surveillance in Minnesota, USA, 2019\u20132021"],"prefix":"10.1093","volume":"233","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3553-9263","authenticated-orcid":false,"given":"Daniel","family":"Evans","sequence":"first","affiliation":[{"name":"Health Protection Bureau, Minnesota Department of Health , St. Paul, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2434-132X","authenticated-orcid":false,"given":"Bree","family":"Friedman","sequence":"additional","affiliation":[{"name":"Health Protection Bureau, Minnesota Department of Health , St. Paul, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1972-9960","authenticated-orcid":false,"given":"Kelly","family":"Pung","sequence":"additional","affiliation":[{"name":"Health Protection Bureau, Minnesota Department of Health , St. Paul, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bonnie","family":"Weber","sequence":"additional","affiliation":[{"name":"Health Protection Bureau, Minnesota Department of Health , St. Paul, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Plumb","sequence":"additional","affiliation":[{"name":"Health Protection Bureau, Minnesota Department of Health , St. Paul, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4120-2376","authenticated-orcid":false,"given":"Jacob","family":"Garfin","sequence":"additional","affiliation":[{"name":"Health Protection Bureau, Minnesota Department of Health , St. Paul, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Lees","sequence":"additional","affiliation":[{"name":"Health Protection Bureau, Minnesota 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