{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:49:52Z","timestamp":1786117792993,"version":"build-2736575974"},"reference-count":68,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Clostridioides difficile<\/jats:italic>\n                      colonization (CDC) is considered an important potential reservoir for subsequent infection, yet its role in patients with chronic kidney disease (CKD) remains unclear. A over 2-year cross-sectional study was conducted at one hospital in Zhejiang, China. Fecal specimens collected from outpatients in the nephrology department were subjected to\n                      <jats:italic toggle=\"yes\">C. difficile<\/jats:italic>\n                      isolation. Isolates were further characterized through toxin gene detection, multilocus sequence typing, whole-genome sequencing, and antimicrobial susceptibility testing. Demographic data were also collected for statistical analysis. Among the 323 patients with CKD enrolled in this study, approximately 5.0% (16\/323) were colonized with\n                      <jats:italic toggle=\"yes\">C. difficile<\/jats:italic>\n                      . The 16\n                      <jats:italic toggle=\"yes\">C. difficile<\/jats:italic>\n                      isolates comprised 9 toxin A-negative, toxin B-positive, and binary toxin-negative (A\n                      <jats:sup>\u2212<\/jats:sup>\n                      B\n                      <jats:sup>+<\/jats:sup>\n                      CDT\n                      <jats:sup>\u2212<\/jats:sup>\n                      ), 1 A\n                      <jats:sup>\u2212<\/jats:sup>\n                      B\n                      <jats:sup>+<\/jats:sup>\n                      CDT\n                      <jats:sup>+<\/jats:sup>\n                      , 2 A\n                      <jats:sup>+<\/jats:sup>\n                      B\n                      <jats:sup>+<\/jats:sup>\n                      CDT\n                      <jats:sup>\u2212<\/jats:sup>\n                      , and 4 A\n                      <jats:sup>\u2212<\/jats:sup>\n                      B\n                      <jats:sup>\u2212<\/jats:sup>\n                      CDT\n                      <jats:sup>\u2212<\/jats:sup>\n                      , yielding 8 sequence types. All the isolates were susceptible to vancomycin and metronidazole, and significant associations were found between resistance to erythromycin and tetracycline and toxin genotypes (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.009 and 0.002). Multivariable regression analysis revealed that hyperphosphatemia (OR = 1.18; 95% CI, 1.048\u20131.065) and hemodialysis frequency (OR = 1.10; 95% CI, 1.023\u20131.467) were independent risk factors for CDC. This study provides the first systematic characterization of the epidemiological profile of CDC in patients with CKD in China; hyperphosphatemia and high-frequency hemodialysis were first identified as independent risk factors for CDC.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        <jats:italic toggle=\"yes\">Clostridioides difficile<\/jats:italic>\n                        is one of the main causative agents of antibiotic-associated and hospital-associated diarrhea. This study provides the first systematic molecular epidemiological analysis of\n                        <jats:italic toggle=\"yes\">Clostridioides difficile<\/jats:italic>\n                        colonization (CDC) among outpatients with chronic kidney disease (CKD) in eastern China, revealing a colonization rate of 5.0%. Hyperphosphatemia and frequent hemodialysis were established as independent risk factors for CDC. While all isolates retained susceptibility to first-line antimicrobials, they exhibited substantial resistance to fluoroquinolones and clindamycin. These findings address a significant gap in local epidemiological data related to this high-risk cohort and indicate that CKD outpatients may represent an underrecognized potential source for the transmission of antimicrobial-resistant\n                        <jats:italic toggle=\"yes\">C. difficile<\/jats:italic>\n                        . Consequently, this study offers an evidence base to strengthen infection prevention and control in nephrology care settings across China. In addition, these preliminary findings also suggest that active surveillance and risk-stratified strategies may be worth considering in other immunocompromised populations.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.00418-26","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T13:01:38Z","timestamp":1784293298000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Molecular epidemiology of\n                    <i>Clostridioides difficile<\/i>\n                    colonization in patients with chronic kidney disease in eastern China"],"prefix":"10.1128","volume":"14","author":[{"given":"Weihong","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Nephrology, The Third People's Hospital of Anji County","place":["Huzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0001-1064","authenticated-orcid":false,"given":"Hangcong","family":"Xu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05gpas306","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Public Health, Hangzhou Medical College","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinwei","family":"Chen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05gpas306","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Public Health, Hangzhou Medical College","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Song","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05gpas306","id-type":"ROR","asserted-by":"publisher"}],"name":"Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People\u2019s Hospital, Hangzhou Medical College","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunhua","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Third People's Hospital of Anji County","place":["Huzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dudu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Third People's Hospital of Anji County","place":["Huzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianzhong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Third People's Hospital of Anji County","place":["Huzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7713-4849","authenticated-orcid":false,"given":"Yun","family":"Luo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03r8z3t63","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Biotechnology and Biomolecular Sciences, University of New South Wales","place":["Sydney, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0315-9415","authenticated-orcid":true,"given":"Yu","family":"Chen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05gpas306","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Public Health, Hangzhou Medical College","place":["Hangzhou, China"]},{"id":[{"id":"https:\/\/ror.org\/05gpas306","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Laboratory Medicine, Hangzhou Medical College","place":["Hangzhou, China"]},{"id":[{"id":"https:\/\/ror.org\/05gpas306","id-type":"ROR","asserted-by":"publisher"}],"name":"Zhejiang Key Laboratory of High-level Biosafety and Biomedical Transformation, Hangzhou Medical College","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2613-7844","authenticated-orcid":true,"given":"Dazhi","family":"Jin","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05gpas306","id-type":"ROR","asserted-by":"publisher"}],"name":"Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People\u2019s Hospital, Hangzhou Medical College","place":["Hangzhou, China"]},{"id":[{"id":"https:\/\/ror.org\/05gpas306","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Laboratory Medicine, Hangzhou Medical College","place":["Hangzhou, China"]},{"id":[{"id":"https:\/\/ror.org\/05gpas306","id-type":"ROR","asserted-by":"publisher"}],"name":"Zhejiang Key Laboratory of High-level Biosafety and Biomedical Transformation, Hangzhou Medical College","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197803092981003"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2006.01580.x"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2020.8"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.20452\/pamw.4377"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.5009\/gnl.2014.8.1.1"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-199958002-00013"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1086\/496986"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.70297"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy149"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens13020140"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/tid.13053"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis319"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-015-3714-9"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.12672"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/5466656"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3111-z"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/srep37865"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-14-523"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.000028"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112137-20250928-02512"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.70092"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00021-17"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.anaerobe.2014.07.003"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.9.2.214-219.1979"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.15.3.443-446.1982"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.30.2.514-516.1992"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa051590"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.12.5710-5714.2004"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01796-09"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.5.1933-1939.2004"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1128\/msphere.00186-25"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2025.1644051"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1093\/gigascience\/giab096"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1099\/mgen.0.000748"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.01623-23"},{"key":"e_1_3_4_37_2","volume-title":"Performance standards for antimicrobial susceptibility testing M100-S22","author":"Clinical and Laboratory Standards Institute","year":"2012","unstructured":"Clinical and Laboratory Standards Institute. 2012. Performance standards for antimicrobial susceptibility testing M100-S22. National Committee for Clinical and Laboratory Standards, Wayne, PA."},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00479-06"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.47176-0"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2022.217"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.14064"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2021.10.010"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2025.101613"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.3747\/pdi.2014.00057"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-020-01734-8"},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.anaerobe.2022.102540"},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.1101\/2023.09.26.23295023"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-020-05030-6"},{"key":"e_1_3_4_49_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2021.651520"},{"key":"e_1_3_4_50_2","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.14424"},{"key":"e_1_3_4_51_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2023.115972"},{"key":"e_1_3_4_52_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12071141"},{"key":"e_1_3_4_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2024.119728"},{"key":"e_1_3_4_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2024.07.006"},{"key":"e_1_3_4_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2022.09.004"},{"key":"e_1_3_4_56_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01898-16"},{"key":"e_1_3_4_57_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40121-021-00417-7"},{"key":"e_1_3_4_58_2","doi-asserted-by":"publisher","DOI":"10.1177\/2049936115622891"},{"key":"e_1_3_4_59_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0127026"},{"key":"e_1_3_4_60_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-17523-7"},{"key":"e_1_3_4_61_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11060785"},{"key":"e_1_3_4_62_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu16050671"},{"key":"e_1_3_4_63_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofaa476"},{"key":"e_1_3_4_64_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.13785"},{"key":"e_1_3_4_65_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-31048-2"},{"key":"e_1_3_4_66_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu17091587"},{"key":"e_1_3_4_67_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59050959"},{"key":"e_1_3_4_68_2","doi-asserted-by":"publisher","DOI":"10.1136\/jim-2016-000183"},{"key":"e_1_3_4_69_2","doi-asserted-by":"publisher","DOI":"10.2217\/fmb.14.2"}],"container-title":["Microbiology Spectrum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.00418-26","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.00418-26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T14:39:43Z","timestamp":1786027183000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.00418-26"}},"subtitle":[],"editor":[{"given":"Megan H.","family":"Amerson-Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":68,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8,4]]}},"alternative-id":["10.1128\/spectrum.00418-26"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.00418-26","relation":{},"ISSN":["2165-0497"],"issn-type":[{"value":"2165-0497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]},"assertion":[{"value":"2026-02-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00418-26"}}