Flooding and Clostridium difficile Infection: A Case-Crossover Analysis

International Journal of Environmental Research and Public Health

Cynthia J. Lin¹  Timothy J. Wade²  Elizabeth D. Hilborn² 

[1] University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC 27599, USA; E-Mail:;USA Environmental Protection Agency (EPA), Office of Research and Development, National Health and Environmental Effects Research Laboratory, Environmental Public Health Division, Research Triangle Park, NC 27709, USA; E-Mail:

关键词: epidemiology;    Clostridium difficile;    community-associated;    flooding;    case-crossover;   

DOI  :  10.3390/ijerph120606948

来源: mdpi

【 摘 要 】

Clostridium difficile is a bacterium that can spread by water. It often causes acute gastrointestinal illness in older adults who are hospitalized and/or receiving antibiotics; however, community-associated infections affecting otherwise healthy individuals have become more commonly reported. A case-crossover study was used to assess emergency room (ER) and outpatient visits for C. difficile infection following flood events in Massachusetts from 2003 through 2007. Exposure status was based on whether or not a flood occurred prior to the case/control date during the following risk periods: 0–6 days, 7–13 days, 14–20 days, and 21–27 days. Fixed-effects logistic regression was used to estimate the risk of diagnosis with C. difficile infection following a flood. There were 129 flood events and 1575 diagnoses of C. difficile infection. Among working age adults (19–64 years), ER and outpatient visits for C. difficile infection were elevated during the 7–13 days following a flood (Odds Ratio, OR = 1.69; 95% Confidence Interval, CI: 0.84, 3.37). This association was more substantial among males (OR = 3.21; 95% CI: 1.01–10.19). Associations during other risk periods were not observed (p < 0.05). Although we were unable to differentiate community-associated versus nosocomial infections, a potential increase in C. difficile infections should be considered as more flooding is projected due to climate change.

【 授权许可】

CC BY   
© 2015 by the authors; licensee MDPI, Basel, Switzerland.