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Flooding and Clostridium difficile Infection: A Case-Crossover Analysis

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  • Cynthia J. Lin

    (University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC 27599, USA
    Oak Ridge Institute for Science and Education (ORISE) Research Participation Program at the U.S. Environmental Protection Agency, Chapel Hill, NC 27599, USA)

  • Timothy J. Wade

    (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)

  • Elizabeth D. Hilborn

    (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)

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.

Suggested Citation

  • Cynthia J. Lin & Timothy J. Wade & Elizabeth D. Hilborn, 2015. "Flooding and Clostridium difficile Infection: A Case-Crossover Analysis," IJERPH, MDPI, vol. 12(6), pages 1-17, June.
    • Handle: RePEc:gam:jijerp:v:12:y:2015:i:6:p:6948-6964:d:51268
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    References listed on IDEAS

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    1. Imad M Tleyjeh & Aref A Bin Abdulhak & Muhammad Riaz & Faisal A Alasmari & Musa A Garbati & Mushabab AlGhamdi & Abdur Rahman Khan & Mohamad Al Tannir & Patricia J Erwin & Talal Ibrahim & Abed AlLehibi, 2012. "Association between Proton Pump Inhibitor Therapy and Clostridium difficile Infection: A Contemporary Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-12, December.
    2. Paul Kirshen & Chris Watson & Ellen Douglas & Allen Gontz & Jawon Lee & Yong Tian, 2008. "Coastal flooding in the Northeastern United States due to climate change," Mitigation and Adaptation Strategies for Global Change, Springer, vol. 13(5), pages 437-451, June.
    3. P. C. D. Milly & R. T. Wetherald & K. A. Dunne & T. L. Delworth, 2002. "Increasing risk of great floods in a changing climate," Nature, Nature, vol. 415(6871), pages 514-517, January.
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    Cited by:

    1. Samuel Dorevitch, 2015. "Health Effects of Waterborne Contaminants: A Focus on Emerging Concerns," IJERPH, MDPI, vol. 12(10), pages 1-3, October.

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