C lostridioides (formerly Clostridium) diffi cile was considered to be a predominantly nosocomial pathogen until fi ndings of several whole-genome sequencing studies suggested a more complex epidemiology. For example, Eyre et al. reported that only 35% of nosocomial C. diffi cile infections (CDIs) were potentially attributable to other cases on the basis of genomic data, and only 19% were additionally linked through sharing possible hospital-based contact (1). This fi nding suggests that a major proportion of C. diffi cile from CDI cases occurring in healthcare institutions originates from other sources, including the community (2).Community-associated CDI (CA-CDI) is now well recognized, accounting for ≈25% of cases in Australia, <25% of cases in Europe, and 33% of cases in the United States (3,4). There is increasing recognition that C. diffi cile is a near ubiquitous environmental organism and that humans have widespread environmental exposure to it. C. diffi cile has been detected in samples from parks (24.6%); water sources, including rivers, lakes, and sea water; homes (17.1%); commercial stores; and other premises (6.5%-8.1%), in addition to hospitals (16.5%) (5,6). Isolates of C. diffi cile