Su Chen LimDeirdre A. CollinsKorakrit ImwattanaDaniel R. KnightSicilia PerumalsamyNatasza M.R. Hain-SaundersPapanin PutsathitDavid SpeersThomas V. RileySiriraj HospitalEdith Cowan UniversityPathWest Laboratory Medicine WAThe University of Western AustraliaMurdoch University2022-08-042022-08-042021-01-01Journal of Applied Microbiology. (2021)13652672136450722-s2.0-85121458218https://repository.li.mahidol.ac.th/handle/20.500.14594/76320Aims: To investigate if Clostridium (Clostridioides) difficile infection (CDI), traditionally thought of as hospital-acquired, can be genomically linked to hospital or community environmental sources, and to define possible importation routes from the community to the hospital. Methods and Results: In 2019, C. difficile was isolated from 89/300 (29.7%) floor and 96/300 (32.0%) shoe sole samples at a tertiary hospital in Western Australia. Non-toxigenic C. difficile ribotype (RT) 010 predominated among floor (96.6%) and shoe sole (73.2%) isolates, while toxigenic RT 014/020 was most prevalent among contemporaneous clinical cases (33.0%) at the hospital. Whole-genome sequencing and high-resolution core genome single nucleotide polymorphism (cgSNP) analysis on C. difficile strains from hospital and community sources showed no clinical C. difficile RT 014/020 strains were genetically related, and evidence of frequent long-distance, multi-directional spread between humans, animals and the environment. In addition, cgSNP analysis of environmental RT 010 strains suggested transportation of C. difficile via shoe soles. Conclusions: While C. difficile RT 014/020 appears to spread via routes outside the healthcare system, RT 010 displayed a pattern of possible importation from the community into the hospital. Significance and Impact of Study: These findings suggest developing community-based infection prevention and control strategies could significantly lower rates of CDI in the hospital setting.Mahidol UniversityBiochemistry, Genetics and Molecular BiologyImmunology and MicrobiologyArticleSCOPUS10.1111/jam.15408