After repeated C. diff infections, people change their behaviors

Many patients reported they wash their hands (46.7 percent) and use soap and water for washing and bathing (44.9 percent) much more often. But there is little or no evidence to support some other behavior changes, including avoiding or adding certain foods (reported by 31.4 percent of patients), increasing the use of probiotic supplements (26.3 percent) and avoiding shared places such as public bathrooms or restaurant buffets (26.3 percent).

The study, led by Loyola University Chicago and Hines VA Hospital researcher Frances M. Weaver, PhD, is published in the journal Infection Control and Hospital Epidemiology. Weaver is a professor in Loyola's Department of Public Health Sciences and director of Hines' Center of Innovation for Complex Chronic Healthcare.

"While some behaviors are appropriate (e.g. handwashing) others are not supported by evidence of decreased risk and may negatively impact patient quality of life," Dr. Weaver and colleagues wrote.

Infection by the bacterium Clostridium difficile, or C. diff, can cause diarrhea, abdominal pain, fatigue, headache, fever, light-headedness, nausea and weight loss. In 2011, there were an estimated 453,000 C. diff cases in the United States, and approximately 6.5 percent of these patients died.

Researchers surveyed 119 patients who had suffered recurrent C. diff infections, to better understand how their illness affected their behaviors. (Recurrent infection was defined as a second episode of C. diff within 15 to 56 days of an initial episode.) Patients were treated at seven Chicago area hospitals that belong to the Chicago Area Patient Reported Outcomes Research Network (CAPriCORN).

Survey respondents' average age was 57. Fifty percent said they had been hospitalized with C. diff or a diarrhea-related illness in the past three years; 58.5 percent rated their diarrhea as severe; 30.7 percent reported severe exhaustion; 29.1 percent reported severe abdominal pain; 55.6 percent said they were worried about getting sick again and 37.3 percent were worried about being contagious.

Increased hand washing and use of soap and water for cleaning have been shown to significantly reduce the likelihood of acquiring and transmitting infections. But there is little evidence to suggest that changes in diet reduce the risk of contracting C. diff. The use of probiotics (yogurt and other microorganism-based products) have received extensive media coverage, but using probiotics to prevent C. diff "is still controversial because of the conflicting findings across studies," researchers wrote. Respondents who said they eat out less and/or avoid shared and public places "may be adversely impacting their quality of life without changing their risk of future illness," researchers wrote.

Certain medications, including antibiotics and proton pump inhibitors to treat heartburn, increase the risk of C. diff infections. But 46.6 percent of respondents did not avoid such medications.

Researchers concluded that doctors should provide pamphlets, waiting-room videos and other information about how to prevent C. diff. Doctors also should explain that other behaviors, such as eating out less, "will not affect their risk of future illness but could negatively affect their quality of life."