{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:41:15Z","timestamp":1785426075894,"version":"3.56.0"},"reference-count":46,"publisher":"American Society for Microbiology","issue":"12","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100004844","name":"National Cheng Kung University Hospital","doi-asserted-by":"publisher","award":["NCKUH-11410014"],"award-info":[{"award-number":["NCKUH-11410014"]}],"id":[{"id":"10.13039\/501100004844","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100019803","name":"Center for Health Sciences, Oklahoma State University","doi-asserted-by":"publisher","award":["Startup"],"award-info":[{"award-number":["Startup"]}],"id":[{"id":"10.13039\/100019803","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,12,2]]},"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                      infection is a global health concern, with increasing community-associated cases. Environmental sources may contribute to transmission. This study assessed hypervirulent\n                      <jats:italic toggle=\"yes\">C. difficile<\/jats:italic>\n                      in wastewater and shellfish in southern Taiwan. From April to September 2020, water samples were collected from two domestic wastewater treatment plants (WWTPs), one hospital WWTP, and shellfish from an aquafarm in Tainan City.\n                      <jats:italic toggle=\"yes\">C. difficile<\/jats:italic>\n                      isolates underwent molecular identification, toxin gene detection, ribotyping, antimicrobial susceptibility, and multi-locus variable-number tandem repeat analysis (MLVA). Ninety-seven\n                      <jats:italic toggle=\"yes\">C. difficile<\/jats:italic>\n                      isolates representing 24 ribotypes were classified into 29 distinct strains\u20144, 13, and 12 from domestic WWTPs, hospital WWTP, and shellfish, respectively. Among 17 WWTP strains, 64.7% were toxigenic. Hypervirulent RT078 family strains (RT598, RT126, and RT127) with \u039439 base-pair deletion in toxin production control protein C gene were detected in WWTPs. One RT027 strain was discovered in clams\u2014the first environmental report of RT027 in Taiwan. MLVA revealed this strain\u2019s association with the American Type Culture Collection reference strain but distinct from other clinical strains. Five hypervirulent isolates harbored Thr82\u2192Ile mutation in DNA gyrase subunit A, conferring high-level fluoroquinolone resistance (minimum inhibitory concentration &gt;32 mg\/L) while remaining susceptible to metronidazole and vancomycin. This first detection of hypervirulent RT078 in wastewater and RT027 in shellfish in Taiwan indicates that environmental reservoirs may contribute to community-associated infections, highlighting the need for expanded surveillance.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        This study assessed the presence of\n                        <jats:italic toggle=\"yes\">Clostridioides difficile<\/jats:italic>\n                        in wastewater and shellfish from southern Taiwan. Water samples were collected from both household and hospital treatment plants, along with clams from a local aquafarm. We identified several strains of\n                        <jats:italic toggle=\"yes\">C. difficile<\/jats:italic>\n                        , including types specifically dangerous and resistant to certain antibiotics, such as fluoroquinolones. Notably, the hypervirulent RT027 strain, associated with severe infections in humans, was detected in shellfish, marking the first report of RT027 in environmental samples in Taiwan. Our findings indicate that food and water sources may contribute to the community transmission of\n                        <jats:italic toggle=\"yes\">C. difficile<\/jats:italic>\n                        , highlighting the significance of ongoing environmental surveillance.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.01377-25","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T12:00:33Z","timestamp":1761566433000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":1,"title":["Environmental reservoirs of hypervirulent\n                    <i>Clostridioides difficile<\/i>\n                    : RT078 strains in wastewater and first detection of RT027 in shellfish in Taiwan"],"prefix":"10.1128","volume":"13","author":[{"given":"Te-Wei","family":"Yang","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01b8kcc49","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9391-1561","authenticated-orcid":true,"given":"Chin-Shiang","family":"Tsai","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01b8kcc49","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University","place":["Tainan, Taiwan"]},{"id":[{"id":"https:\/\/ror.org\/01b8kcc49","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medicine, College of Medicine, National Cheng Kung 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