Date of Conferral





Public Health


Maria Rangel


Clostridium difficile is a frequent cause of healthcare-associated infections (HAI) and is associated with increased risk of morbidity and mortality. Studies suggest environmental and host characteristics increase patient's susceptibility to C. difficile infection (CDI). However, few studies have examined the risk of CDI among those with diabetes or patients in the acute rehabilitation (AR) setting. A case-control study, using secondary data (n = 473), evaluated the relationship between CDI and diabetes and identified modifiable environmental exposures. An ecosocial framework was used to examine the relationship between these two complex diseases among hospitalized patients in an AR setting. Results of the multiple logistic regression showed that patients with diabetes experienced 2.5 times the risk for CDI (p = 0.03) compared to non-diabetic patients. Multiple logistic regression was also used to assess for modifiable exposures among AR patients with diabetes only. Findings from this sub-analysis found the significant exposures in this population were antibiotics (OR = 3.9; p = 0.01) and insulin use (OR = 2.6; p = 0.015), suggesting an effect on the intestinal microbiome. Understanding the relationship between CDI and diabetes among the AR population promotes positive social change through the reduction of CDI associated morbidity and mortality among diabetic patients. Findings from this study support antibiotic stewardship efforts across the spectrum of healthcare delivery and the development of new strategies to decrease the economic burden associated with CDI for individuals, healthcare facilities, and at the national level.