Patients Alter Behavior After C. difficile Encounter

Clostridium difficile (C. difficile) preventative measures seem to increase after a patient experienced a recurrent infection, according to a new report.

Researchers from the Loyola University in Chicago used a computer algorithm to search 7 Chicago-area hospital records to identify recurrent C. difficile infected patients. The patients, infected and reinfected within 5—15 days of the initial episode qualified for the study, which looked at hospital patients admitted between Jan. 1, 2013–Oct. 31, 2015. The team then contacted patients by mail, inviting them to participate in a telephone interview answering questions about recurrent C. difficile infection or a diarrhea-related illness.

In the survey, investigators asked 119 patients about general health status, then specifically about the patients’ C. difficile experience, such as days of hospitalizations and antibiotic use. The interviewers also asked patients about emotional distress issues, such as the fear of getting sick again, fear of getting others sick, shame/embarrassment, and the like.

Finally, researchers ended with questions about changes in behaviors, like hand washing, cleaning their homes, use of bleach, use of soap and water, changes in diet, changes in medication, avoidance of public areas, and use of probiotics.

About 60% of the patients reported severe C. difficile infection cases and about a third reported having severe abdominal pain, the investigators found.

Patients seemed to be most worried about getting sick again (55%) and about being contagious (37%), according to the researchers. Fear of dying and worries about intimacy also made the list, at about 17% of patients each.

Study authors described the changes in patients’ behavior as “fall[ing] into extremes.” They discovered that either patients displayed essentially no behavioral changes or drastically changed their behavior.

Nearly half of the patients said hand washing occurs much more frequently, while 45% of patients increased their use of soap and water. About a third of patients reported increasing their cleaning-related behaviors, such as using bleach, general household cleaning, and use of antibacterial wipes or gels.

Some patients (between 22—32%), said they changed their diets — behaviors like eating out less, avoiding certain medications, avoiding public areas, and/or increasing their use of probiotics.

Study author Frances Weaver, PhD, (pictured) told MD Magazine the evidence to support these types of dietary changes to avoid getting C. difficile “either doesn't exist or is conflicting.”

“For example, there is no evidence that a person should avoid eating out in restaurants to avoid getting c diff again,” Weaver noted. “These changes can negatively affect the person's quality of life without having any effect on getting sick.”

Researchers also noted that while not statistically significant, a trend related disease severity to behavioral changes. Those who were hospitalized seemed to have changed their eating habits more than those without hospitalization, the authors added.

“It would be important for providers to talk with patients who have had recurrent C. difficile infection about what behaviors they should follow (washing hands with soap and water) and which behaviors are not related (such as what you eat, or eating in public places),” Weaver continued, adding that evidence of taking probiotics to reduce the risk of C. difficile is mixed at best. “This could be done with a pamphlet, a brief video, or by the nurse.”

The paper, titled “The Impact of Recurrent Clostridium difficile Infection on Patients' Prevention Behaviors,” was published in the journal Infection Control & Hospital Epidemiology.