Date of Award

Spring 5-11-2012

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Lisa Casanova

Second Advisor

Dr. Frances McCarty



Clostridium difficile is a Gram-positive bacteria found in the large bowel or colon that causes mild to severe intestinal conditions and sometimes death. The primary risk factors for development of Clostridium difficile infection (CDI) include healthcare exposure and recent antimicrobial use. The purpose of this study is to compare risk factors associated with CDI occurring in the Community to those associated with Healthcare Facility Associated CDI in the metro Atlanta population from September 1, 2009 – April 30, 2011.


Patients were identified through C. difficile surveillance program of the Georgia Emerging Infections Program (EIP). Prospective, population based, laboratory based surveillance for all positive C. difficile cases in the Georgia Health District 3 (HD3). Due to the sampling scheme, for this analysis CO-HCFA and HCFO cases were combined to make a Healthcare Facility Associated (HCFA) classification. Using SAS, a logistic regression analysis was performed to compare the associated risks between CA and HCFA classifications.


The rate of CDI in the HD3 counties in Georgia is 84 per 100,000. The median age of infection is 63 and the age range in this study is 1 to 102 years old. CA cases represented 38% of the sampled population. CDI cases 65 and older were more likely to have a Healthcare association compared to CA-CDI cases (p


This study supports literature about CDI and antimicrobial use and looks further in to the role underlying conditions play as a risk factor for HCFA-CDI cases.