1930. Quality of Life among Patients with Community-onset Clostridioides difficile Infection (CDI) without Subsequent Hospitalization
Authors: Schmidt Mark A , Kuntz Jennifer L , Shuster Elizabeth , Contreras Richard , Donald Judy L , Barreras Joanna L , Angulo Fredrick J , Yu Holly , Gonzalez Elisa , Zamparo Joann M , Florea Ana , Tartof Sara Y 
Published: November 2023

Abstract

Background
Clostridioides difficile infections increasingly occur among persons who are diagnosed and receive care in the outpatient setting. We explored the impact of outpatient C. difficile infection (oCDI) on patients’ healthcare-related quality of life (HRQoL).

Methods
We conducted this prospective study of adults aged ≥ 50 years within the Kaiser Permanente Southern California (KPSC) and Northwest (KPNW) healthcare delivery systems. We identified and recruited individuals with oCDI, defined as laboratory-confirmed CDI with no hospitalization on or in 7 days after diagnosis. To assess HRQoL associated with oCDI, we administered the Cdiff32, a CDI-specific HRQoL questionnaire, shortly after oCDI diagnosis. We also administered the EQ-5D-5L, a generic HRQoL questionnaire, at baseline and approximately 60 days after oCDI to collect Visual Analog Scales (VAS) and Indices pre-infection, on the worst day of illness, and 60 days after diagnosis.

Results
Our study included 213 cases. Most were female 143 (67%), 77 (36%) were 60-69 years of age, and 167 (78%) reported no prior CDI. From the CDiff32, 77 (36%) reported pretty or very bad quality of life over the past week and 80 (38%) thought their oCDI made their health condition(s) worse. Within the EQ-5D-5L, 118 (55%) reported having moderate, severe, or complete inability to complete daily activities during the worst day of illness, compared to 20% pre-infection. Cases reported a median pre-infection VAS of 80.0, compared with 44.5 on the worst day of illness (p&lt; 0.0001 vs pre-infection) and 80.0 at 60-days of follow up (p&lt; 0.0001 vs worst day; 0.8129 vs pre-infection). Cases also reported median Index values of 0.9 pre-infection, 0.6 on worst day of illness (p&lt; 0.0001 vs pre-infection), and 0.9 at 60 days of follow-up (p&lt; 0.0001 vs worst day and p=0.0081 vs pre-infection).

Conclusion
Even when managed within the outpatient setting, patients experienced a significant reduction in HRQoL during their CDI episode.

Disclosures
Mark A. Schmidt, PhD, MPH, Intercept Pharmaceuticals: Grant/Research Support|Pfizer: Grant/Research Support|Vir Biotechnology: Grant/Research Support Jennifer L. Kuntz, MS, PhD, Pfizer: Grant/Research Support Fredrick J. Angulo, DVM, PhD, Pfizer Vaccines: Employee|Pfizer Vaccines: Employee|Pfizer Vaccines: Stocks/Bonds|Pfizer Vaccines: Stocks/Bonds Holly Yu, MSPH, Pfizer, Inc,: employee of Pfizer, Inc|Pfizer, Inc,: Stocks/Bonds Elisa Gonzalez, MPH, Pfizer: Stocks/Bonds Joann M. Zamparo, MPH, Pfizer Inc.: Full Time Employee|Pfizer Inc.: Stocks/Bonds Ana Florea, PhD MPH, Gilead: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Sara Y. Tartof, PhD MPH, Genentech: Grant/Research Support|GSK: Grant/Research Support|Pfizer: Grant/Research Support|SPERO: Grant/Research Support