Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Louise-Marie Dembry


Clostridium difficile is the leading cause of hospital-acquired diarrhea. Oncology patients are a group of immunosuppressed patients who are at increased risk for C. difficile infection. The primary objective of this study was to describe the demographic factors, medical history, and clinical characteristics and identify risk factors for C. difficile infection among oncology patients. A retrospective chart review was conducted for this case-control study. Seventy-seven cases were compared to two control groups; one control group of patients with diarrhea but whose stool samples were tested and were negative for C. difficile (n=77), and a second control group of patients matched to cases based on hospital ward and date of discharge (n=152). Multivariate analyses were performed using logistic regression. Adjusting for all other variables, days of hospitalization prior to test (OR=1.075, 95% CI 1.027, 1.124), fever on test date (OR=5.232, 95% CI 1.460, 18.755), history of C. difficile (OR=32.433, 95% CI 3.513, 299.445), and hypotension on test date (OR=9.245, 95% CI 1.232, 69.183) were significantly associated with C. difficile infection in cases compared to the negative test control group. When cases were compared to the matched control group, age (OR=1.042, 95% CI 1.006, 1.079), history of any co-infection (OR=5.614, 95% CI 1.878, 16.787), blood transfusion (OR=3.200, 95% CI 1.251, 8.183), prior receipt of cephalosporins (OR=4.214, 95% CI 1.371, 12.952) or metronidazole (OR=16.005, 95% CI 3.958, 64.713), chemotherapy (OR=5.069, 95% CI 1.609, 15.972), history of C. difficile (OR=27.806, 95% CI 2.484, 311.290), and use of a nasogastric tube (OR=6.988, 95% CI 1.339, 36.477) were significantly associated with C. difficile infection. Risk factors for C. difficile infection differed when comparing cases to the negative test control group and to the matched control group; however, prior history of C. difficile was a common risk factor. Based on the analysis of the matched control group, reduction in cephalosporin and metronidazole use, particularly among patients with a history of C. difficile infection, recent chemotherapy or blood transfusions, or presence of a nasogastric tube, may reduce the risk of C. difficile infection and should be a focus of future study and intervention.


This is an Open Access Thesis.