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Etiology of Community Acquired Clostridium
Difficile-Associated Disease

By: Shannan Sherman and Dr. Pamela Ark | Mentor: Dr. Pamela Ark


In this integrated review of the research literature, there were a number of limitations. Most studies were retrospective studies that relied on medical records for data. Therefore, the studies were limited by the fact that primary care medical records were not available. Also, emergency department records did not always state previous antibiotic use. Another limitation was a lack of access to medical records from other care providers. Some patients may not have sought medical care in some instances, or physicians may not have considered or recorded the diagnosis of diarrhea in the medical record. In general practice, most laboratories only performed testing based on requests from the physicians for community acquired specimens; therefore, it is likely that only symptomatic patients were tested.

One study (Levy et al., 2000) looked at medical claims rather than medical records. This limits the amount of information received. For example, the medical claim dose not report the dose or duration of antibiotic prescribed.

The laboratory tests performed to detect C. difficile toxins could also be a limitation. Each study qualified community acquired disease versus hospital acquired disease differently. In addition, each test has the potential to give false results. Furthermore, C. difficile isolates that were not typed could not be studied for different C. difficile variants.

A majority of the nine studies examined had a large population pool. However, two did not (Simor, Yake & Tsimidis and McFarland, Clarridge, Beneda & Raugi). These two studies cannot be generalized because both the long term care population and veterans population respectively consists of mostly older adults with a significant number of comorbidities.

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