Hospital-acquired Clostridium difficile diarrhoea and herd immunity

Lancet. 1997 Feb 8;349(9049):426-8. doi: 10.1016/S0140-6736(97)80053-0.


Clostridium difficile diarrhoea represents a significant health-service burden. We recently experienced an outbreak of C difficile diarrhoea associated with increased use of cefotaxime. The question we pose in this paper is how did the introduction and withdrawal of a single antibiotic so greatly affect rates of C difficile diarrhoea? Other antibiotics had nearly as high a risk of causing diarrhoea as cefotaxime, and the majority of patients never received cefotaxime. We believe that such outbreaks of C difficile diarrhoea are best understood in terms of a population model, and that taking antibiotics like cefotaxime should be thought of as a population rather than an individual risk factor. We postulate a herd-immunity model of C difficile diarrhoea, and examine the implications of this hypothesis.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Clostridioides difficile*
  • Diarrhea / epidemiology*
  • Diarrhea / immunology
  • Diarrhea / microbiology
  • Diarrhea / prevention & control
  • Disease Outbreaks*
  • Enterocolitis, Pseudomembranous / epidemiology*
  • Enterocolitis, Pseudomembranous / immunology
  • Enterocolitis, Pseudomembranous / prevention & control
  • Humans
  • Immunity*
  • Infection Control / methods
  • Models, Theoretical
  • Population


  • Anti-Bacterial Agents