Figure 4.

Longitudinal Clostridioides difficile carriage. Patient samples are indicated with circles. Blue indicates a VRE swab and red a toxin-positive stool sample. Filled circles are samples that produced isolates for sequencing. The number of days between samples is indicated by the number between the circles. A, Asymptomatic carriers. Carried isolates remained in the same SNP cluster for all patients. B, Asymptomatic carriers who developed CDI. In patient 57, a strain from a different cluster was cultured from the positive stool sample. In patient 69, a strain different from the previously carried and CDI-causing strain was detected 56 days after CDI diagnosis and treatment. C, Patients with CDI with subsequent asymptomatic carriage. In patient 171, a different strain was identified 5 days after CDI diagnosis and start of therapy. Abbreviations: CDI, Clostridioides difficile infection; SNP, single nucleotide polymorphism; VRE, vancomycin-resistant enterococci.