Identification of Novel Cryptic and Classical Clades in Clostridioides difficile

Abstract

Clostridioides difficile is a major cause of nosocomial infections and antimicrobial-associated diarrhea, with significant global health implications. While five classical clades (C1 to C5) have traditionally encompassed most pathogenic strains, recent genomic studies have uncovered several highly divergent cryptic clades (C-I to C-V), suggesting greater taxonomic and evolutionary complexity. In this study, we performed a comprehensive whole-genome analysis of 25,144 publicly available C. difficile genomes, supplemented with 21 novel isolates from Costa Rica and Brazil. Using average nucleotide identity (ANI), recombination-corrected core-genome phylogenies, we confirmed the presence of all known classical and cryptic clades and identified two novel classical clades (C6 and C7) and two previously undescribed cryptic clades (C-VI and C-VII). We further detected evidence for bifurcation within cryptic clade C-III, supporting its division into two lineages C-IIIa and C-IIIb. ANI comparisons revealed that cryptic clades share less than 95% identity with classical C. difficile strains but remain more similar to C. difficile than to any other Peptostreptococcaceae species, reinforcing their placement within the species boundary. Core-genome recombination analyses revealed limited gene flow between cryptic and classical clades, except for Clade C7, which exhibited intermediate recombination patterns and may represent a transitional lineage. These findings expand the known diversity of C. difficile, provide a revised genomic framework for clade classification, and underscore the evolutionary depth and ecological breadth of cryptic lineages with potential clinical relevance.