Background/Objectives: Antimicrobial resistance (AMR) remains a major topic of interest in infectious disease management. We studied AMR in Clostridioides difficile isolated in Cambodia. Methods: Agar dilution susceptibility testing was performed according to the CLSI guidelines to determine minimal inhibitory concentrations (MICs) of 10 antimicrobials for 192 isolates of C. difficile from four populations in Cambodia: hospitalised adults, hospitalised children, children from an outpatient department (OPD), and healthy adolescents in the community. Results: Using the CLSI MIC breakpoints for anaerobes and EUCAST breakpoints for C. difficile, all isolates were susceptible to vancomycin, metronidazole, fidaxomicin, and amoxicillin/clavulanic acid, and none were resistant to meropenem. The resistance proportions were for clindamycin, 88% (169/192); tetracycline, 50% (96/192); moxifloxacin, 20% (38/192); and rifaximin, 8% (15/192). Among the 169 clindamycin-resistant isolates, 56.8% (96/169) had an erythromycin MIC of >512 mg/L. Multidrug resistance (MDR) occurred in 20% (39/192) of the isolates, of which 82% (32/39) were non-toxigenic strains. The proportion of MDR varied between collections of isolates from different populations: 28.6% (22/77) in hospitalised adults, 29.8% (14/47) in hospitalised children, 5% (3/59) in OPD children, and none (00/07) in healthy adolescents in the community. Conclusions: C. difficile isolates from Cambodia remained susceptible to antimicrobials used to treat C. difficile infection: vancomycin, metronidazole, and fidaxomicin; however, high proportions of resistance to clindamycin and tetracycline were observed. The high number of MDR strains of C. difficile is a threat to AMR management in Cambodia and a factor contributing to the persistent spread of C. difficile in both hospital and community settings.

Despite historically being considered a healthcare-associated pathogen, rates of Clostridioides difficile infection in the community have risen greatly in recent decades. As a pathogen of One Health importance, sources of C. difficile in the community have been sought to understand and control community-associated C. difficile infection transmission. This study aimed to investigate the prevalence and molecular characteristics of C. difficile isolated from retail garden products in two Australian states. Soil conditioners, soil mixes and turf samples were collected from commercial garden product suppliers in Western Australia and Queensland from May 2023 to January 2024. Following enrichment culture, PCR ribotyping and toxin gene profiling were performed on C. difficile isolates. C. difficile was recovered from 257 of 479 (53.7 %) retail garden products in this study. Prevalence was highest in turf (67.1 %, 53/79), followed by soil mixes (57.1 %, 148/259) and soil conditioners (39.7 %, 56/141). Of the 113 distinct ribotypes identified, the most common were 014/020 and QX 686. Toxigenic ribotypes associated with both human infection and production animals in Australia, including 014/020, 056 and 087, were recovered. A high prevalence of C. difficile was found in garden products sold to consumers, including toxigenic strains associated with C. difficile infection in humans and animals. More discriminatory characterisation of isolates is required to determine if retail garden products contribute to the burden of community-associated C. difficile infection in Australia.