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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: With regard to the comments by Dr van Staa and colleagues, the effect of reporting and the effect of increasing numbers of C difficile cases are difficult to disentangle. We agree that the magnitude of the rise we described needs to be interpreted with caution. Nevertheless, our analysis controlled for the impact of such potential reporting trends by matching on calendar time.

Dr Leffler and colleagues raise a number of issues. First, regarding antibiotic use, the 2 studies that they cite are much smaller than ours, but nonetheless support the concept that community-acquired CDAD does occur and that prior antibiotic exposure may be less frequent in that setting. Most studies are on nosocomial CDAD where antibiotic use is very prevalent, and we calculated a pooled prevalence of 72% antibiotic exposure in controls with a corresponding 96% exposure in CDAD cases in these studies. This high prevalence of antibiotic . . . [Full Text of this Article]

Sandra Dial, MD, MSc
sandra.dial@mcgill.ca
Division of Critical Care and Respiratory and Clinical Research

J. A. C. Delaney, MSc; Alan N. Barkun, MD, MSc; Samy Suissa, PhD
Division of Clinical Epidemiology
McGill University Health Centre
Montreal, Quebec

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