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This study aimed to elucidate the clinical and epidemiological features of HA-CDI and the characteristics of <jats:italic>C.difficile<\/jats:italic> isolates in Chongqing, Southwest China.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A case-control study was performed to identify the clinical incidence and risk factors of HA-CDI. <jats:italic>C. difficile<\/jats:italic> isolates were characterised by polymerase chain reaction (PCR) ribotyping, multilocus sequence typing (MLST), toxin gene detection and antimicrobial susceptibility testing.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 175 suspicious patients, a total of 122 patients with antibiotic-associated diarrhea (AAD) were included in the study; among them, 38 had HA-CDI. The incidence of AAD and HA-CDI was 0.58 and 0.18 per 1000 patient admissions, respectively. Chronic renal disease and cephalosporin use were independent risk factors for HA-CDI. Fifty-five strains were assigned into 16 sequence types (STs) and 15 ribotypes (RTs). ST2\/RT449 (8, 14.5%) was the predominant genotype. Of the 38 toxigenic isolates, A\u2009+\u2009B\u2009+\u2009CDT- isolates accounted for most (34, 89.5%) and 1 A\u2009+\u2009B\u2009+\u2009CDT+ isolate emerged. No isolate was resistant to vancomycin, metronidazole or tigecycline, with A-B-CDT- being more resistant than A\u2009+\u2009B\u2009+\u2009CDT-.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Different genotypes of <jats:italic>C. difficile<\/jats:italic> strains were witnessed in Chongqing, which hinted at the necessary surveillance of HA-CDI. Adequate awareness of patients at high risk of HA-CDI acquisition is advocated and cautious adoption of cephalosporins should be highlighted.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12879-020-05014-6","type":"journal-article","created":{"date-parts":[[2020,4,15]],"date-time":"2020-04-15T11:03:17Z","timestamp":1586948597000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China"],"prefix":"10.1186","volume":"20","author":[{"given":"Wei","family":"Dai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianxiang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siqiang","family":"Niu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanming","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jide","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,4,15]]},"reference":[{"issue":"2","key":"5014_CR1","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1177\/2050640617736987","volume":"6","author":"J Cai","year":"2018","unstructured":"Cai J, Zhao C, Du Y, Zhang Y, Zhao M, Zhao Q, et al. 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