Patients often change behavior after recurrent C. difficile infection

Many patients who have had repeated Clostridium difficile infections change their behaviors in hopes of preventing future infection, according to findings recently published in Infection Control & Hospital Epidemiology.

However, researchers noted that although some behaviors are appropriate for avoiding C. difficile infection, or CDI, others are not supported by clinical evidence and may needlessly harm patients’ quality of life.

“A substantial number of people experience recurrent CDI,” Dale N. Gerding, MD, professor of medicine in the division of infectious diseases at Loyola University Chicago Stritch School of Medicine, and colleagues wrote. “Despite detailed information about the increasing prevalence and costs associated with CDI and [recurrent CDI], very little is known about the impact that infection may have on patients’ lives.”

The researchers used medical records to identify patients with repeated CDIs from seven Chicago-area hospitals. All patients had at least two episodes of CDI within 15 to 56 days of each other. Gerding and colleagues performed a survey of these patients via telephone, asking them questions about social isolation, general health, severity of symptoms, emotional distress and prevention behaviors.

One hundred and nineteen patients (32%) completed the survey. The mean age of respondents was 57.4 years, and most (57%) were white. Approximately half reported that they had been hospitalized for CDI.

Most patients reported having severe diarrhea in their most recent bout of infection (58.5%), whereas a substantial portion reported extreme exhaustion (30.7%). More than one-third of respondents said they were worried about getting sick again (41.5%), and 31% said they were worried about infecting other people.

Gerding and colleagues wrote that 47% of patients began washing their hands more frequently, and 45% of patients increased their use of soap and water after recurrent infections. One-third of patients responded that household cleaning, such as use of antibacterial wipes or gels, changed “a great deal.”

Although hand hygiene is shown to reduce infection risk, the researchers wrote, another 22% to 32% of patients also reported that they went out to eat at restaurants less, avoided public areas, avoided certain medications and increased their probiotic use.

Despite the fact that probiotic use has received positive media attention, Gerding and colleagues wrote that using probiotics to avoid CDI “is still controversial because of the conflicting findings across studies.”

“Providers should provide information (eg, pamphlets and/or waiting-room videos) about appropriate prevention behaviors to their CDI patients, and they should clarify that other behaviors (eg, eating out less) will not affect their risk of future illness but could negatively affect their quality of life,” the researchers wrote. – by Andy Polhamus

 

Disclosures: Gerding is a board member of Acetelion, Bobiotix Summit and Merck, and serves as a consulting for Binder, DaVolterra, Groove, Minor, Pfizer and Sanofi Pasteur.