Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

James Hadler

Second Advisor

David Banach


Background: Treatment guidelines for Clostridioides difficile infection (CDI) were updated by the Infectious Disease Society of America (IDSA) & the Society for Healthcare Epidemiology of America (SHEA) in 2017 making various modifications, most notably for disease severity & treatment recommendations. Our objectives were to assess Connecticut medical providers’ concordance (2017-2019) to the 2017 SHEA/IDSA clinical treatment guidelines. The effect of guideline concordance on the risk of CDI recurrence was also assessed.

Methods: Using data from the Connecticut Emerging Infections Program’s CDI surveillance in New Haven County, severity & concordance were defined for CDI cases. For severity, white blood cell count >15,000 & presence of megacolon and/or ileus were used. Concordant treatment was defined as receiving the recommended first-line antibiotic (vancomycin for adult patients, vancomycin or metronidazole for pediatric patients) for exactly 10 days. In univariate & multivariate analyses, significance was determined by a p-value of

Results: Of the 1,216 New Haven County incident cases eligible for the study (50.7%) from 2017 - 2019, an overall concordance of 23.0% was identified, increasing from 10.0% in 2017 to 36.9% in 2019. Concordance with initial choice of first line treatment increased from 40.2% in 2017 to 80.8% in 2019. Overall concordance was highest for cases with fulminant disease (62.2%). The recurrence rate was 11.2% & was highest for patients with non-severe disease & older age but was not significantly associated with treatment concordance.

Conclusion: From 2017 through 2019, CDI treatment in New Haven County increasingly was concordant with the updated 2017 IDSA/SHEA guidelines, but as of 2019, the overall level was still low except for those with severe disease. Although concordance with treatment did not affect recurrence risk, close attention should be paid by medical providers to patients who are classified as non-severe and/or elderly as they are at an increased risk for recurrence.


This is an Open Access Thesis.

Open Access

This Article is Open Access