title: Flooding and Clostridium difficile Infection: A Case-Crossover Analysis.
abstract: 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.
authors.affiliation: University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC 27599, USA. cjlin@email.unc.edu.|Oak Ridge Institute for Science and Education (ORISE) Research Participation Program at the U.S. Environmental Protection Agency, Chapel Hill, NC 27599, USA. cjlin@email.unc.edu.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Lin
authors.affiliation: 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. Wade.Tim@epa.gov.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wade
authors.affiliation: 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. Hilborn.E@epa.gov.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Hilborn
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000904:Antibiotics, Antitubercular; D057231:Climate Change; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology*; D018592:Cross-Over Studies; D005260:Female; D055868:Floods; D006801:Humans; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000904:Antibiotics, Antitubercular
keywords: Clostridium difficile; case-crossover; community-associated; epidemiology; flooding