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Flooding and Clostridium difficile infection: a case-crossover analysis
Citation:
Lin, C., Tim Wade, AND E Hilborn. Flooding and Clostridium difficile infection: a case-crossover analysis. International Journal of Environmental Research and Public Health. Molecular Diversity Preservation International, Basel, Switzerland, 12(6):6948-6964, (2015).
Impact/Purpose:
Clostridium difficile is an important cause of severe diarrhea in the developed world. Most cases of infection are associated with antibiotic therapy or hospitalization, but recently, increased numbers of infections are acquired in the community without evidence of these risk factors. Recent evidence suggests that C. difficile is an emerging and potentially waterborne pathogen. Because of the low infective dose and the environmental persistence of the organism, we investigate if floods are a potential risk factor for infection. Using a case crossover analysis of flood events, with emergency room and outpatient health care visits for C. difficile, we find that risk of illness is increased in the 7-14 days after a flood among adult male residents of flood-impacted towns. We find that the risk of C. difficile infection is significantly increased after a flood among adult men. This is an example of a potential public health threat associated with the flooding that is expected to accompany climate change in the northeastern United States.
Description:
Clostridium difficile is a bacterium that can spread by water. It often causes acute gastrointestinal illness in older adults who are hospttalized 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, Cl: 0.84, 3.37). This association was more substantial among males (OR = 3.21; 95% Cl: 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.
