Molecular characteristics, clonal transmission, and risk factors of Clostridioides difficile among hospitalized patients in a tertiary hospital in Ningbo, China

Nosocomial transmission of infection (CDI) has been documented in Ningbo, China. However, data on molecular characteristics, clonal transmission, and risk factors of CDI in this region remain limited. A cross-sectional study enrolled hospitalized patients with diarrhea during September to November 2021. Stool samples from all patients were tested for , and isolated strains underwent toxin gene identification, genotyping, and antibiotic susceptibility testing. Whole-genome sequencing and epidemiological variables were analyzed in patients infected with strains of the same sequence types (STs) to identify nosocomial transmission and risk factors for CDI. Of the 907 investigated patients, 115 (12.7%) had microbiologically proven CDI, as their diarrhea was associated with toxigenic strains, which comprised 106 A B CDT , 3 A B CDT , and 6 A B CDT . Predominant genotypes (ST2, ST3, ST35, and ST54) exhibited distinct antibiotic resistance patterns. ST54 strains showed higher resistance to erythromycin (100%) but lower resistance to moxifloxacin (18.2%) and gatifloxacin (18.2%) ( = 10.24-16.65,