Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Louise-Marie Dembry

Second Advisor

Richard Martinello


Introduction: Over the past several years, Clostridioides difficile infection (CDI) incidence has been rising. The primary risk factor for CDI is antibiotic use. Many studies indicate that penicillin drugs are among the low-risk antibiotic classes associated with CDI whereas cephalosporin drugs are among the high-risk antibiotic classes. However, there is variation in studies evaluating the healthcare-associated CDI (HA-CDI) risk associated with antibiotics within a class and limited data comparing the use of penicillin versus cephalosporin drugs.

Methods: An observational cohort study was performed using patient data from BH and YNHH. Minitab (Version 18) was used to perform survival analysis and multivariate logistic regression. Charlson comorbidity index scores were utilized to control and adjust for underlying comorbidities, and adjusted odds ratios were calculated using backwards elimination.

Results: Data collected from a 5-year period between February 1, 2013 and June 1, 2018 revealed that piperacillin/tazobactam exposure at YNHH was associated with a higher CDI risk than penicillin exposure (p = 0.016). Additional covariates included H2A use (OR = 0.497, p = 0.027), Charlson comorbidity index scores (OR = 0.848, p = 0.025), and longer duration of hospital admission (OR = 1.038, p < 0.001).

Discussion: The findings in the YNHH cohort may justify an investigation into de-escalation of piperacillin/tazobactam empiric therapy intended for suspected infection caused by Gram-negative bacteria. Further study is needed to better address the association between the covariates and CDI risk in the BH cohort. Next steps may include an aggregate analysis of CDI risk between penicillin drugs and cephalosporin drugs along with a closer exploration of the facility and individual-level factors at both hospitals.

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