{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:42:21Z","timestamp":1785436941811,"version":"3.56.0"},"reference-count":39,"publisher":"American Society for Microbiology","issue":"5","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2024YFC2309902"],"award-info":[{"award-number":["2024YFC2309902"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Research Project of Jinan Microecological Biomedicine Shandong Laborato","award":["JNL-2025004B"],"award-info":[{"award-number":["JNL-2025004B"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,5,5]]},"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 (CDI) imposes considerable medical and economic burdens on patients and healthcare systems due to its high recurrence rate and treatment refractoriness. Recurrent CDI (rCDI) may result from a relapse of the same strain or reinfection by a different strain. However, the genetic and evolutionary features of strains causing rCDI remain poorly understood. Therefore, in this study, CDI strains were collected from patients with \u22652 clinically defined infections. Through antimicrobial susceptibility testing and whole-genome sequencing (WGS), we investigated the correlation between relapse and reinfection strains. WGS revealed that 40 of 82 patients with CDI (48.8%) relapsed with the original strain, including 6 cases exceeding the 8-week recurrence interval definition. The recurrence interval was significantly shorter for relapse cases than for reinfections. Moreover, the relapse rate was significantly higher in hospital-associated (HA-CDI) cases than in community-associated (CA-CDI) cases (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Notably, strains isolated from relapse cases showed a trend toward higher resistance rates to clindamycin, imipenem, moxifloxacin, and tigecycline than those from reinfection cases. No significant genomic differences, including resistance genes, virulence genes, and transposons, were observed between relapse and reinfection strains. Core genome evolutionary analyses indicated that both types were predominantly under purifying selection, with only a few genes related to transcriptional regulation and energy metabolism under positive selection. The findings indicate that relapse and reinfection strains share similar evolutionary drivers, suggesting that recurrence may be more closely associated with other factors, such as host gut microbiota or gene expression regulation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Clostridioides difficile<\/jats:italic>\n                      infection (CDI) poses a major challenge in healthcare settings due to its high recurrence rate. Accurate differentiation between relapse of the original strain and reinfection with a new strain is crucial for effective management of recurrent\n                      <jats:italic toggle=\"yes\">Clostridioides difficile<\/jats:italic>\n                      infection (rCDI). This study combined whole-genome sequencing (WGS) and antimicrobial susceptibility testing to thoroughly examine the genomic characteristics of isolates from rCDI patients at our hospital, aiming to identify potential genomic features and key factors contributing to rCDI. Core genome analysis revealed highly consistent evolutionary trajectories between recurrent and reinfection strains, with no significant differences in their genetic lineages. This finding suggests that recurrence tendencies may be influenced more by host-specific factors or regulatory adaptations. These insights offer a new direction for developing targeted management strategies for rCDI.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.04087-25","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T13:12:00Z","timestamp":1774617120000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Whole-genome characteristics of isolates from recurrent\n                    <i>Clostridioides difficile<\/i>\n                    infections"],"prefix":"10.1128","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2835-5873","authenticated-orcid":false,"given":"Lisi","family":"Zheng","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0232r4451","id-type":"ROR","asserted-by":"publisher"}],"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, China-Singapore Belt and Road Joint Laboratory on Infection Research and Drug Development, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, People\u2019s Republic of China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Lv","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0232r4451","id-type":"ROR","asserted-by":"publisher"}],"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, China-Singapore Belt and Road Joint Laboratory on Infection Research and Drug Development, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of 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People\u2019s Republic of China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4677-6747","authenticated-orcid":true,"given":"Ping","family":"Shen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0232r4451","id-type":"ROR","asserted-by":"publisher"}],"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, China-Singapore Belt and Road Joint Laboratory on Infection Research and Drug Development, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, People\u2019s Republic of 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