{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:47:23Z","timestamp":1785822443349,"version":"3.56.0"},"reference-count":42,"publisher":"Frontiers Media SA","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\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Clostridioides difficile<\/jats:italic>\n                      infection (CDI) remains an important healthcare-associated infection worldwide. However, the molecular epidemiology of CDI in county-level hospitals across China remains poorly understood. Therefore, this study aimed to investigate the clinical and molecular epidemiology of CDI in a county-level hospital in Zhejiang Province, China.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Between January and December 2025, we conducted a genomic epidemiology study of\n                      <jats:italic>C. difficile<\/jats:italic>\n                      isolates recovered from patients with clinically suspected CDI at a county-level hospital in Zhejiang Province, China.\n                      <jats:italic>C. difficile<\/jats:italic>\n                      strains were isolated and identified, typed by multi-locus sequence typing (MLST), and phylogenetic analysis, core-genome single-nucleotide polymorphism (cgSNP) analysis, and antimicrobial resistance (AMR) genes identification were extracted from whole genome sequencing. Antimicrobial susceptibility testing was performed using the agar dilution method according to CLSI guidelines. Statistical analysis was performed using R\/Python.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 50 (3.8%) toxigenic\n                      <jats:italic>C. difficile<\/jats:italic>\n                      isolates were identified from a total 1,315 stool samples. Among them, 40 (80.0%) exhibited the\n                      <jats:italic>tcdA<\/jats:italic>\n                      +\/\n                      <jats:italic>tcdB<\/jats:italic>\n                      +\/CDT\u2013 profile, 8 (16.0%) exhibited the\n                      <jats:italic>tcdA<\/jats:italic>\n                      \u2013\/\n                      <jats:italic>tcdB<\/jats:italic>\n                      +\/CDT\u2013 profile, and 2 (4.0%) exhibited the\n                      <jats:italic>tcdA<\/jats:italic>\n                      +\/\n                      <jats:italic>tcdB<\/jats:italic>\n                      +\/CDT+ profile. And 16 (32.0%) strains were isolated from the Digestive department, followed by 8 (16.0%) strains from the Rehabilitation department. The most sequence type of the toxigenic\n                      <jats:italic>C. difficile<\/jats:italic>\n                      was ST2 (14.0%) and ST3 (14.0%), followed by ST81 (12.0%), ST35 (10.0%) and ST129 (8.0%). cgSNP-based minimum spanning tree analysis provided genomic evidence compatible with potential nosocomial transmission, including ST3, ST35, ST81, and ST129, with closely related isolates identified both within and between departments. Furthermore, all toxigenic isolates were successfully analyzed for antimicrobial susceptibility phenotype and remained susceptible to vancomycin, metronidazole, tigecycline, daptomycin, and fidaxomicin. High resistance rates were observed for clindamycin and erythromycin, while moderate resistance to tetracycline and moxifloxacin was also detected. Resistance phenotypes generally correlated with the presence of corresponding resistance determinants, including\n                      <jats:italic>ermB, tetM<\/jats:italic>\n                      , and the\n                      <jats:italic>gyrA<\/jats:italic>\n                      (Thr82Ile) mutation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This study provides insight into the molecular epidemiology and antimicrobial resistance characteristics of toxigenic\n                      <jats:italic>C. difficile<\/jats:italic>\n                      in a county-level hospital in China. Our findings show potential healthcare-associated transmission of several predominant lineages and highlight the importance of continuous genomic surveillance and strengthened infection prevention and control strategies to limit the dissemination of epidemic and multidrug-resistant\n                      <jats:italic>C. difficile<\/jats:italic>\n                      strains in healthcare settings.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmicb.2026.1882254","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:36:35Z","timestamp":1785821795000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and molecular epidemiology of Clostridioides difficile infection in a county-level hospital in Zhejiang Province, China"],"prefix":"10.3389","volume":"17","author":[{"given":"Meihong","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Chun'an County hospital of Traditional Chinese Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Chun'an County hospital of Traditional Chinese Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisi","family":"Zheng","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiajing","family":"Bi","sequence":"additional","affiliation":[{"name":"Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Chun'an County hospital of Traditional Chinese Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiying","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Chun'an County hospital of Traditional Chinese Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Lv","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunbo","family":"Chen","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1038\/nrgastro.2010.190","article-title":"Clostridium difficile infection: epidemiology, risk factors and management","volume":"8","author":"Ananthakrishnan","year":"2011","journal-title":"Nat. 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