Patient Experiences with Clostridioides difficile Infection: Results of a Canada-Wide Survey

Clostridioides difficile infection (CDI) is the most prevalent cause of nosocomial infectious diarrhea in Canada and is highly correlated with antibiotic use and contact with health care facilitates. The often-severe symptoms of CDI include diarrhea, dehydration, and abdominal pain. Patients often relapse following symptom resolution, resulting in increased morbidity. Previous research on the impact of CDI centered around the health-care system, clinician perspectives and economic burden, but not on patient experiences. The purpose of this study was to understand the impact of CDI on patients in Canada.

The Gastrointestinal Society conducted online surveys and gathered data from 167 qualifying participants, who were either patients or their non-treating caregivers. Quantitative parameters were analyzed by descriptive and comparative statistics and contextualized with qualitative insights derived from thematic analysis of open-ended questions.

Our findings, which focused on clinical parameters such as prior exposure to health-care settings, antibiotic use, and patients' symptoms, mirrored findings from previous research. Interestingly, most surveyed respondents experienced delays in diagnosis and treatment; 29% waited 6-30 days and 10% over 30 days. This delayed diagnosis was further complicated by the report that 62% of respondents did not experience symptom resolution within 7 days of initiating treatment. Importantly, our results suggest a lasting impact after the resolution of CDI and we saw a reduction of self-assessed quality of life from prior to post CDI. Patients' priorities regarding their experience with CDI focused around concerns about the health-care system, particularly time to diagnosis and treatment, concerns about antibiotic usage and needs from health-care providers.

This is the first Canadian report on patients' experience with CDI. Our data highlight the symptom-related impact on patients and the long-lasting effect on the quality of life including emotional impact. Reducing time to diagnosis and improving patient education are important priorities to attenuate the impact on patients.