C Difficile Infections Linked to Poor Quality of Life Scores

Generally speaking patients who are hospitalized with Clostridioides difficile infections (CDI) suffer from a lower quality of life.

A team, led by Zheyi Han, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, examined quality of life metrics for patients hospitalized with C difficile infections.

The Study

In the prospective survey study, the investigators reviewed 100 adults hospitalized with CDI at a US tertiary-care referral center, acute-care setting. A C difficile infection was defined as at least 3 episodes of unformed stool in a 24 hour period, as well as a positive laboratory test for C difficile.

The mean age of the patient population was 8.6 ±17.1 years.

Patients were surveyed between July 2019 and March 2020. The survey was conducted using the disease-specific Cdiff32 questionnaire and the generic PROMIS GH survey.

The investigators compared differences using 2-sample t tests in Cdiff32 scores among demographic and clinical subgroups, which included CDI severity, CDI recurrence, and various comorbidities.

PROMIS GH scores were compared to the general population using T score of 50 using 1-sample t tests. The investigators also identified predictors of Cdiff32 scores using multivariable linear regression.

Quality of Life

The results show PROMIS GH physical health summary scores (T = 37.3; P <.001) and mental health summary scores (T = 43.4; P <.001) were significantly lower in comparison to the general population.

For the subgroups, recurrent CDI, severe CDI, and the number of stools were linked to lower Cdiff32 scores after using bivariate analysis.

In addition, multivariable linear regression showed recurrent CDI, severe CDI, and each additional stool in the preceding 24 hours were associated with significantly decreased Cdiff32 scores.

“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 authors wrote. “The Cdiff32 questionnaire is particularly sensitive to QoL changes in patients with recurrent or severe disease.”

A Decrease in C Difficile Infections

Masking, patient and visitor access restrictions, and all the other mitigation measures put in place during the COVID-19 pandemic has contributed to a precipitous drop in Clostridioides difficile infections (CDI).

A team, led by Simona Sipos, Department of Pharmacology, ‘Victor Babes’ University of Medicine and Pharmacy of Timisoara, analyzed whether the preventative measures put in place to curb the spread of COVID-19 may have affected the spread of healthcare-associated C difficile infections as well in a large regional acute care center.

When COVID-19 began to spread, hospitals around the world implemented new registrations in an effort to stop the spread. These recommendations included face masks, limiting the duration of interpersonal contact, disinfecting surfaces, creating hand hygiene stations with alcohol-based rubs and soap and water, and glove routes.

Other measures include designated routes and limits to unnecessary patient movement, reducing hospital lengths of stay, decreasing patient density, isolating patients as much as possible, an adherence to strict no touch-packaged meals, limiting outside visitors, and increasing the terminal disinfection of rooms.

The study, “Impact of Clostridioides difficile infection on patient-reported quality of life,” was published online in Infection Control & Hospital Epidemiology.