Identification of pathways to high-level vancomycin resistance in Clostridioides difficile that incur high fitness costs in key pathogenicity traits

Clostridioides difficile is a human pathogen primarily treated with the antibiotic vancomycin. High-level vancomycin resistance is a serious problem in other pathogens, not yet for C. difficile. This study identifies two resistance pathways in C. difficile, which evolve rapidly but with fitness costs that could affect transmission.