<p dir="ltr">This study aimed to evaluate the performance of the gradient strip method with the agar dilution method for determining the minimum inhibitory concentrations (MICs) of MTZ and VAN against C. difficile, assess the reproducibility of the gradient strip method, and explore the correlation between genotypic characteristics and phenotypic AMR patterns.</p><p dir="ltr">This retrospective cohort study examined 150 deduplicated clinical C. difficile isolates collected from Queen Elizabeth Hospital, Kwong Wah Hospital and Queen Mary Hospital in Hong Kong between 2023 and 2024. The MIC values for MTZ and VAN were determined for each isolate using both the agar dilution (reference method) and gradient strip methods, with their essential (EA) and categorical (CA) agreement calculated according to the US Food and DrugAdministration’s (FDA) criteria. The reproducibility was assessed using technical replicates and represented by Bland-Altman plots. Lastly, phenotypic MICs of the isolates were compared with their corresponding genetic AMR profiles determined by whole genome sequencing.</p>