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To the Editor: Dr Dial and colleagues¹ studied the risk of developing CDAD in individuals who were taking acid antisecretory agents. We have major concerns regarding the validity of the CDAD diagnoses and inadequate controlling for confounding variables.

The most striking finding of this study was that, of the 1233 patients with community-acquired CDAD, 791 (64%) had no apparent exposure to antibiotics in the preceding 90 days. Although the authors note several possible reasons for this result, the finding is difficult to reconcile with data from other studies. Hirschhorn et al² performed a health maintenance organization-based study of community-acquired CDAD and found that 33 of the 51 community-acquired CDAD cases (65%) had antibiotics dispensed from one of the health maintenance organization pharmacies in the preceding 6 weeks alone. Noren et al³ found that in a cohort of 372 patients with CDAD, in which 59 cases were community-acquired, 98% had received . . . [Full Text of this Article]

Daniel Leffler, MD, MS
dleffler@caregroup.harvard.edu
Department of Gastroenterology

Jeffery W. Cloud, MD
Department of Infectious Disease

Ciaran P. Kelly, MD
Department of Gastroenterology
Beth Israel Deaconess Medical Center
Boston, Mass

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