{
  "abstract": "BackgroundClostridioides difficile infections (CDI) continue to cause substantial morbidity and mortality, with increasing incidence in some countries post-COVID-19. Recurrence affects 10-20% of CDI patients: whether risk factors have changed over time is unclear, particularly post-COVID-19.\n\nMethodsUsing electronic health records from hospitals in Oxfordshire, UK, including results from community samples, we estimated the incidence of CDI recurrence across different calendar periods between 2000-2025. To investigate whether risk factors had changed over time, we used interaction tests within multivariable Fine-Gray regression models (modelling death as a competing risk), using backwards elimination, starting from 39 risk factors identified from the literature.\n\nResultsRecurrence occurred within 1-year in 12.6%, 12.5%, 10.8% and 13.1% of CDI cases in \"high virulence\" 2003-2008 (n=527), \"post-high virulence\" 2008-2012 (n=252), \"pre-pandemic\" 2012-2020 (n=143) and \"post-pandemic\" 2020-2025 (n=110) periods respectively. The only factor with evidence of variation in its association with recurrence over time was surveillance classification (heterogeneity p=0.019; others p>0.05). Compared with hospital-onset cases, community-onset community-associated cases had increasing recurrence risks over time (subdistribution hazard ratios (SHRs)=2.05 (95% CI 1.27-3.31) in \"post-pandemic\" and 1.86 (1.16-2.98) in \"pre-pandemic\"), especially compared to the \"high virulence\" era of the early 2000s (SHR=0.81 (0.56-1.16)). This heterogeneity persisted after adjusting for baseline blood tests as a marker of severity (heterogeneity p=0.022).\n\nConclusionsCompared with hospital-onset hospital-associated cases, recurrence risks increased for community-onset community-associated CDI cases over time. Recurrence is a key contributor to overall CDI incidence and the underlying causes of increasing risks with community-onset community-associated cases should be explored further.\n\nShort summaryOver 2000-2025, risk of recurrence following Clostridioides difficile infection increased significantly for community-onset community-associated cases, compared to hospital-onset hospital-associated cases. Older age, hospital exposure, immunosuppression, chronic kidney disease, diverticular disease, enteral feeding and recent sepsis/bacteraemia were significantly associated with recurrence.",
  "abstract_shown": true,
  "affiliations": [
    "University of Oxford"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "E. Dietz"
    },
    {
      "name": "J. Robotham"
    },
    {
      "name": "M. H. Wilcox"
    },
    {
      "name": "C. Brown"
    },
    {
      "name": "R. Hope"
    },
    {
      "name": "B. Muller-Pebody"
    },
    {
      "name": "D. W. Eyre"
    },
    {
      "name": "A. S. Walker"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/83f9ve4jmjx5h.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.30.26364395",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.30.26364395v1.full",
  "id": "83f9ve4jmjx5h",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.30.26364395v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "epidemiology"
    ],
    [
      "openalex",
      "2725|Clostridium difficile and Clostridium perfringens research"
    ]
  ],
  "openalex": "W7215132310",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.30.26364395v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-30",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/83f9ve4jmjx5h.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:53Z",
      "native_id": "10.64898/2026.09.30.26364395",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.30.26364395v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:epidemiology",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Increasing risks of recurrence following community-associated Clostridioides difficile infection in Oxfordshire 2000-2025",
  "title_text": "Increasing risks of recurrence following community-associated Clostridioides difficile infection in Oxfordshire 2000-2025",
  "type": "preprint",
  "updated_at": "2026-10-30T12:19:53Z",
  "url": "https://research.draconitic.com/paper/83f9ve4jmjx5h",
  "venue": "medRxiv",
  "versions": []
}