Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Loretta Cain


Clostridium difficile (C. difficile) infection is a leading cause of morbidity and mortality in the United States, making the infection a top public health priority. Early and accurate identification of disease is a critical factor in successful management, including clinical symptomology. The testing methods for C. difficile have improved in efficiency and sensitivity, which potentially causes over- or underprescribing behavior. Guided by the symbolic theory, the purpose of this study was to examine the association between C. difficile testing method by case year (2015 and 2018) and antibiotic treatment with the potential moderation of clinical symptoms. The secondary correlational analysis included patients admitted to a large suburban hospital with a positive test for C. difficile in 2015 and 2018 (N = 509). The relationship between the study predictor (case year), dependent variable (antibiotic treatment), and moderator (symptom) was analyzed using binomial logistic regression. Antibiotics showed a significant association with the case year (OR = 1.889) and no significant moderation with the addition of symptoms (OR = 1.303). Health care providers may find these findings useful in standardizing treatment of C. difficile through the implementation of additions to clinical algorithms, resulting in positive social change. Increased education, and policy, through antibiotic-resistant organism reduction, increased antimicrobial stewardship, and increased patient safety, may have social implications.