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Defense Date


Document Type


Degree Name

Master of Public Health


Epidemiology & Community Health

First Advisor

Dr. Elizabeth E. Turf

Second Advisor

Spencer E. Harpe


Introduction: Recently, Clostridium difficile has garnered both national and international attention, occurring with greater frequency, severity and resistance to standard treatments. In 2001, Clostridium difficile-associated disease, CDAD, became epidemic and its rate doubled from 2000 to 2003. As a substantial cause of healthcare-associated morbidity, CDAD is no longer just a pharmacotherapy nuisance. Specifically, the objectives of this research are to determine the incidence of both primary and secondary cases of CDAD among patients in the UHC database, determine how many primary cases had previous admissions with secondary cases of CDAD, and determine how many primary cases go on to be readmitted as primary or secondary cases.Methods: This cross-sectional study used the dataset from the University HealthSystem Consortium (UHC) covering the first quarter of 2002 through the second quarter of 2006, to identify the incidence of primary and secondary CDAD within hospitals participating in the UHC's Clinical Resource Manager (CRM) program. The UHC-CRM database was used to provide epidemiologic data in regards to CDAD cases, hospital-wide variables and patient characteristics. The data was analyzed using SAS statistical software.Results: During the time period studied, a total of 17,636 CDAD cases were identified out of 2,805,901 total hospital discharges. Of those, 80.4% or 14,178 fit the definition of primary with 3,454 cases labeled as secondary. The mean discharge rate of primary CDAD cases, per 1,000 adult discharges among CRM-participating hospitals per quarter, ranged from 3.14 (SD 2.33) to 6.72 (SD 4.0). The mean incidence of secondary CDAD per 1,000 adult discharges among CRM-participating hospitals per quarter, ranged from 0.79 (SD 0.74) to 1.59 (SD 0.86). The mean discharge rate of all CDAD cases, per 1,000 (adult discharges) among CRM-participating hospitals per quarter, ranged from 3.93 (SD 3.04) to 8.11 (SD 4.52). The rate of CDAD case discharges shows an increasing trend, more than doubling from 2002 to 2006. Among previous primary CDAD admissions, 7.75% were readmitted as a primary CDAD cases (p-value Conclusions: CDAD cases are on the rise, with all CDAD cases diagnosed on discharge from doubling from 2002 to 2006. There is no current national surveillance system for tracking CDAD cases. This study begins to shed light on the increasing incidence of CDAD cases within the hospital setting. By providing a baseline, future research can use this information to make more extensive tracking and surveillance systems for CDAD cases.


Part of Retrospective ETD Collection, restricted to VCU only.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

June 2008