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In this study,\n                    <jats:italic>C. difficile<\/jats:italic>\n                    was isolated from 47.3% (53\/112) of lake\/pond, 23.0% (14\/61) of river, 20.0% (3\/15) of estuary and 0.0% (0\/89) of seawater samples. The most common toxigenic strain isolated was\n                    <jats:italic>C. difficile<\/jats:italic>\n                    PCR ribotype (RT) 014\/020 (10.5%, 8\/76). All water isolates were susceptible to fidaxomicin, metronidazole, rifaximin, amoxicillin\/clavulanic acid, moxifloxacin and tetracycline. Resistance to vancomycin, clindamycin, erythromycin and meropenem was detected in 5.3% (4\/76), 26.3% (20\/76), 1.3% (1\/76) and 6.6% (5\/76) of isolates, respectively. High\u2010resolution core\u2010genome analysis was performed on RT 014\/020 isolates of water origin and 26 clinical RT 014\/020 isolates from the same year and geographical location. Notably, both human and water strains were intermixed across three sequence types (STs), 2, 13 and 49. Six closely related groups with \u226410 core\u2010genome single nucleotide polymorphisms were identified, five of which comprised human and water strains. Overall, 19.2% (5\/26) of human strains shared a recent genomic relationship with one or more water strains. This study supports the growing hypothesis that environmental contamination by\n                    <jats:italic>C. difficile<\/jats:italic>\n                    plays a role in CDI transmission.\n                  <\/jats:p>","DOI":"10.1111\/1462-2920.15821","type":"journal-article","created":{"date-parts":[[2021,10,24]],"date-time":"2021-10-24T21:36:05Z","timestamp":1635111365000},"page":"1221-1230","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Genetically related\n                    <i>Clostridium difficile<\/i>\n                    from water sources and human\n                    <scp>CDI<\/scp>\n                    cases revealed by whole\u2010genome sequencing"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8983-6573","authenticated-orcid":false,"given":"Su\u2010Chen","family":"Lim","sequence":"first","affiliation":[{"name":"School of Medical and Health Sciences Edith Cowan University  Joondalup WA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasza M. 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