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Only a portion of hospital-acquiredClostridium difficileinfections can be traced back to source patients identified as having symptomatic disease. Antibiotic exposure is the main risk factor forC difficileinfection for individual patients and is also associated with increased asymptomatic shedding. Contact with patients taking antibiotics within the same hospital ward may be a transmission risk factor forC difficileinfection, but this hypothesis has never been tested.

To obtain a complete portrait of inpatient risk that incorporates innate patient risk factors and transmission risk factors measured at the hospital ward level and to investigate ward-level rates of antibiotic use andC difficileinfection risk.

A 46-month (June 1, 2010, through March 31, 2014) retrospective cohort study of inpatients 18 years or older in a large, acute care teaching hospital composed of 16 wards, including …