Impact of Clostridioides difficile infection on patient-reported quality of life

Abstract

Objective: We investigated the quality of life (QoL) of patients hospitalized with C. difficile infection (CDI). Design: Prospective survey study. Setting: US tertiary-care referral center, acute-care setting. Participants: Adults hospitalized with a diagnosis of CDI, defined as ≥3 episodes of unformed stool in 24 hours and a positive laboratory test for C. difficile. Methods: We surveyed patients from July 2019 to March 2020 using the disease-specific Cdiff32 questionnaire and the generic PROMIS GH survey. We compared differences in Cdiff32 scores among demographic and clinical subgroups (including CDI severity, CDI recurrence, and various comorbidities) using 2-sample t tests. We compared PROMIS GH scores to the general population T score of 50 using 1-sample t tests. We performed multivariable linear regression to identify predictors of Cdiff32 scores. Results: In total, 100 inpatients (mean age, 58.6 ±17.1 years; 53.0% male; 87.0% white) diagnosed with CDI completed QoL surveys. PROMIS GH physical health summary scores (T = 37.3; P < .001) and mental health summary scores (T = 43.4; P < .001) were significantly lower than those of the general population. In bivariate analysis, recurrent CDI, severe CDI, and number of stools were associated with lower Cdiff32 scores. In multivariable linear regression, recurrent CDI, severe CDI, and each additional stool in the previous 24 hours were associated with significantly decreased Cdiff32 scores. Conclusions: Patients hospitalized with CDI reported low scores on the Cdiff32 and PROMIS GH, demonstrating a negative impact of CDI on QoL in multiple health domains. The Cdiff32 questionnaire is particularly sensitive to QoL changes in patients with recurrent or severe disease.

Recurrent Clostridioides difficile infection worsens anxiety-related patient-reported quality of life

“…Policy makers and clinical practice guidelines recognize patient-reported outcomes as important endpoints in clinical research and practice [ 8 ]. Consequently, health-related quality of life (HrQOL) measures seem particularly important in patients with CDI [ 3 , 5 , 10 ]. There are different generic tools created for patient-reported outcomes [ 11 ] and quality of life [ 4 – 7 ], however, Cdiff32 is the only instrument specifically developed to assess HrQOL in patients with CDI [ 3 ].…”

“…The strength of this study includes a sizeable cohort as this is the second largest study to date demonstrating quantitative changes of patient-reported HrQOL in CDI [ 3 – 6 , 10 ]. In addition, the current study had rigorous individual patient follow-up providing HrQOL data at two different time points.…”

Navigating the 2021 update to the IDSA/SHEA Clostridioides difficile guidelines: An ethical approach to equitable patient care

“…The panel's heavy emphasis on the avoidance of recurrent CDI is supported by data suggesting that patients with recurrent disease suffer from poorer quality of life. 3 However, several counterarguments can be made with respect to the new recommendations, including increased financial consequences to the patient and health system. Regarding increased costs to the individual, a recent study of Medicare enrollees showed that only 1.1% had access to fidaxomicin and 14.4% had access to vancomycin as a tier 1 or tier 2 medication.…”

“…Furthermore, CDI prolongs hospitalizations, and recent evidence suggests that recurrent and more severe disease are associated with lower quality of life. 3 In 2021, the Infectious Diseases Society of America (IDSA), in collaboration with the Society for Healthcare Epidemiology of America (SHEA), published a focused update with specific recommendations for the treatment of initial CDI, recurrent CDI, and the role of bezlotoxumab. 4 In this article, we review the major recommendation updates, highlight the ethical and clinical dilemmas arising from them, and suggest a principlist approach to addressing these recommendations on individual, programmatic, and healthcare system levels.…”

Optimising Antimicrobial Stewardship to Tackle Clostridioides difficile Infection and Improve Patient Outcomes

“…They often feel depressed and may be in isolation, cutting them off from friends and family. 30 We should not forget that in older patients, diarrhoea often leads to incontinence. This is terrible for the individual's self-respect, and they worry about developing a chronic illness.…”