A Genomic Analysis of Community-Associated C. Difficile Infection Demonstrates Integration With National and International Strain Clusters and Limited Direct Transmission

CA-CDI appears to arise from multiple heterogeneous sources, with transmission varying by strain type and limited evidence of direct transmission. Most isolates clustered within geographically widespread clades, consistent with repeated introductions from reservoirs, such as environmental, animal and food sources rather than sustained local spread highlighting the importance of epidemiologic context when interpreting genomic relatedness. These findings support a One Health approach to understanding CA-CDI spread.