Epidemiology of community-acquired clostridium difficile-associated diarrhea

Lisa R. Hirschhorn*, Yvona Trnka, Andrew Onderdonk, Mei Ling T Lee, Richard Platt

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

198 Scopus citations


The epidemiology of clinically recognized community-acquired Clostridium difficile-associated diarrhea was assessed in a retrospective cohort study of members of a health maintenance organization (HMO). Potential cases were identified through positive toxin assay results and confirmed by review of automated full-text medical records. Of 51 cases identified (7.7 per 100, 000 person-years), 42 (82%) were diagnosed and treated exclusively in the ambulatory care setting; 33 cases occurred within 42 days after 494, 491 exposures to antibiotics dispensed by an HMO pharmacy. Antibiotic-specific attack rates varied from 0 to 2040 cases per 100, 000 exposures. Increased age was associated with C. difjiciie-associated diarrhea (P <.001). Age-adjusted antibiotic-specific attack rates were at least 10-fold higher (P <.05) for nitrofurantoin, cefuroxime, cephalexin plus dicloxacillin, ampicillinjclavulanate plus cefaclor, and ampicillin/clavulanate plus cefuroxime than for ampicillin or amoxicillin; several other antibiotics were associated with similar but not significantly increased risks.

Original languageEnglish (US)
Pages (from-to)127-133
Number of pages7
JournalJournal of Infectious Diseases
Issue number1
StatePublished - Jan 1 1994

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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