Molecular epidemiology of community‐ and hospital‐associated Clostridioides difficile infections in Jönköping, Sweden, October 2017 – March 2018

Clostridioides difficile infections (CDIs) in Sweden are mostly hospital‐associated (HA) with limited knowledge regarding community‐associated (CA) infections. Here, we investigated the molecular epidemiology of clinical isolates of CA‐CDI and HA‐CDI in a Swedish county. Data and isolates (n = 156) of CDI patients (n = 122) from Jönköping county, October 2017–March 2018, were collected and classified as CA (without previous hospital care or onset ≤2 days after admission or >12 weeks after discharge from hospital) or HA (onset >3 days after hospital admission or within 4 weeks after discharge). Molecular characterization of isolates included PCR ribotyping (n = 156 isolates) and whole genome sequencing with single nucleotide polymorphisms (SNP) analysis (n = 53 isolates). We classified 47 patients (39%) as CA‐CDI and 75 (61%) as HA‐CDI. Between CA‐CDI and HA‐CDI patients, we observed no statistically significant differences regarding gender, age, 30‐day mortality or recurrence. Ribotype 005 (RR 3.1; 95% CI: 1.79–5.24) and 020 (RR 2.5; 95% CI: 1.31–4.63) were significantly associated with CA‐CDI. SNP analysis identified seven clusters (0–2 SNP difference) involving 17/53 isolates of both CA‐CDI and HA‐CDI. Molecular epidemiology differed between CA‐CDI and HA‐CDI and WGS analysis suggests transmission of CDI within and between hospitals and communities.