ArticlePloS one2017
Identification of novel risk factors for community-acquired Clostridium difficile infection using spatial statistics and geographic information system analyses.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 32 citations in OpenAlex.
- Reexamining Novel Risk Factors for Community-AcquiredOpen forum infectious diseases · 2026Article
- Colonization Dynamics ofVeterinary sciences · 2026Article
- Zoonotic bacteria in the vicinity of animal farms as a factor disturbing the human microbiome: a review.International journal of occupational medicine and environmental health · 2024Review
- Review
- Burden of Medically Attended Diarrhea and OutpatientOpen forum infectious diseases · 2024Article
- Exposure to industrial hog and poultry operations and urinary tract infections in North Carolina, USA.The Science of the total environment · 2022Article
- Esculin hydrolysis negative and TcdA-only producing strains of Clostridium (Clostridioides) difficile from the environment in Western Australia.Journal of applied microbiology · 2022Article
- Multi-country surveillance of Clostridioides difficile demonstrates high prevalence of spores in non-healthcare environmental settings.Anaerobe · 2022Article
- Clostridioides difficile infection and One Health: an equine perspective.Environmental microbiology · 2022Review
- Human and Porcine Transmission of Clostridioides difficile Ribotype 078, Europe.Emerging infectious diseases · 2021Article
- The use of geographical analysis in assessing the impact of patients' home addresses on their participation in outpatient cardiac rehabilitation: a prospective cohort study.Environmental health and preventive medicine · 2020Article
- Clostridioides difficile infection in US hospitals: a national inpatient sample study.International journal of colorectal disease · 2020Article
- Association Between Environmental Factors and Toxigenic Clostridioides difficile Carriage at Hospital Admission.JAMA network open · 2020Article
- Novel and emerging sources of Clostridioides difficile infection.PLoS pathogens · 2019Review
- Design and Implementation of a Comprehensive Surveillance System for Venous Thromboembolism in a Defined Region Using Electronic and Manual Approaches.Applied clinical informatics · 2019Article
- Association of Community Factors with Hospital-onsetEClinicalMedicine · 2019Article
- Comparing the epidemiology of community- and hospital-associated Clostridium difficile infections in Northern Ireland, 2012-2016: a population data linkage and case-case study.Epidemiology and infection · 2019Article
- Review
- Review
Corrections and comments
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Authors and funding
12 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe rate of community-acquired Clostridium difficile infection (CA-CDI) is increasing. While receipt of antibiotics remains an important risk factor for CDI, studies related to acquisition of C. difficile outside of hospitals are lacking. As a result, risk factors for exposure to C. difficile in community settings have been inadequately studied. MAIN
objectiveTo identify novel environmental risk factors for CA-CDI.
methodsWe performed a population-based retrospective cohort study of patients with CA-CDI from 1/1/2007 through 12/31/2014 in a 10-county area in central North Carolina. 360 Census Tracts in these 10 counties were used as the demographic Geographic Information System (GIS) base-map. Longitude and latitude (X, Y) coordinates were generated from patient home addresses and overlaid to Census Tracts polygons using ArcGIS; ArcView was used to assess "hot-spots" or clusters of CA-CDI. We then constructed a mixed hierarchical model to identify environmental variables independently associated with increased rates of CA-CDI.
resultsA total of 1,895 unique patients met our criteria for CA-CDI. The mean patient age was 54.5 years; 62% were female and 70% were Caucasian. 402 (21%) patient addresses were located in "hot spots" or clusters of CA-CDI (p<0.001). "Hot spot" census tracts were scattered throughout the 10 counties. After adjusting for clustering and population density, age ≥ 60 years (p = 0.03), race (<0.001), proximity to a livestock farm (0.01), proximity to farming raw materials services (0.02), and proximity to a nursing home (0.04) were independently associated with increased rates of CA-CDI.
conclusionsOur study is the first to use spatial statistics and mixed models to identify important environmental risk factors for acquisition of C. difficile and adds to the growing evidence that farm practices may put patients at risk for important drug-resistant infections.
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