Updates in the Treatment of C. difficile Infection: Faculty Insights - OverView - Insights & Updates in Treatment of Prevention of C.difficile INFECTION

CME/CE information

Intended Audience

This activity is intended for gastroenterologists, infectious disease specialists and other healthcare professionals that treat C. difficile infections.

Activity Purpose

CDI is associated with significant morbidity and mortality. Further, recurrence of CDI is common after an initial episode. Although a number of therapies with varying mechanisms of action, are available to treat CDI and prevent recurrence, the management of CDI is complex and challenging. Clinicians require up-to-date knowledge of evidence-based treatment of initial and recurrent CDI to improve clinical outcomes.

Learning Objectives

Upon completion of this curriculum, participants will be able to:
• Discuss recent efficacy and safety data on the treatment of CDI
• Evaluate the clinical practice implications of new data on the prevention and recurrence of CDI

Method of Participation

This activity will take approximately 30 minutes to complete. To receive credit, participants are required to complete the pre-test, view the online activity, and complete the post-test and evaluation forms. To receive credit, 75% must be achieved on the post-test. A certificate will be immediately available. There is no fee to participate in the activity or for the generation of the certificate.

Release date: May 31, 2017
Expiration date: May 31, 2018.

Inquiries may be directed to ACHL at (877) 444-8435, ext. 203.

Faculty Disclosure

The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in a CME/CE activity disclose all affiliations or other financial relationships (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. All conflicts of interest have been resolved prior to this CME/CE activity.

The following financial relationships have been provided:

David Binion, MD (Faculty)
Consulting Agreements: AbbVie, Janssen Biotech and Synthetic Biologics, Inc.
Grants/Research Support: Merck & Company, Shire and UCB Pharma

Paul Feuerstadt, MD, FACG (Faculty)

Consulting Agreements: Merck & Company

Speakers' Bureau: Entera Health, Inc. and Merck & Company

Discussion of Off-Label, Investigational, or Experimental Drug/Device Use: Novel therapies under investigation for the treatment of CDI

Accreditation and Credit Designation

The Academy for Continued Healthcare Learning is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Academy for Continued Healthcare Learning designates this enduring material or a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Supporter Information

This activity is supported by an educational grant from Merck & Company.

Staff Disclosure

ACHL staff members and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.

Disclaimer

The content for this activity was developed independently of the commercial supporter. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantor.

This educational activity was planned and produced in accordance with the ACCME Accreditation Criteria, Policies, and Standards for Commercial Support. Recommendations involving clinical medicine in a continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.

This CME/CE activity might describe the off-label, investigational, or experimental use of medications and/or devices that may exceed their FDA-approved labeling. Physicians should consult the current manufacturers’ prescribing information for these products. ACHL requires the speaker to disclose that a product is not labeled for the use under discussion.

Program Manager

Katlyn Cooper
kcooper@achlcme.org
Phone: (586)453-1845

Resources

Clinician Resources

Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431-55. doi: 10.1086/651706.
Garey KW, Sethi S, Yadav Y, DuPont HL. Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect. 2008;70(4):298-304. doi: 10.1016/j.jhin.2008.08.012.
Hota SS, Sales V, Tomlinson G, et al. Oral vancomycin followed by fecal transplantation versus tapering oral vancomycin treatment for recurrent Clostridium difficile infection: an open-label, randomized controlled trial. Clin Infect Dis. 2017;64(3):265-271. doi: 10.1093/cid/ciw731.
Hu MY, Katchar K, Kyne L, et al. Prospective derivation and validation of a clinical prediction rule for recurrent Clostridium difficile infection. Gastroenterology. 2009;136(4):1206-14.
Johnston BC, Ma SS, Goldenberg JZ, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Ann Intern Med. 2012;157(12):878-88.
Kao DH, Roach B, Silva M, et al. A prospective, non-inferiority, multi-center, randomized trial comparing colonoscop vs oral capsule delivered fecal microbiota transplantation in the treatment of recurrent Clostridium difficile infection. Gastroenterology. 2017;152(5):S190-S191.
Kelly CP, Wilcox M, Glerup H, Aboo N, Eves K, Dorr M. Characteristics and outcomes in patients with C. Difficile Infection (CDI) and inflammatory bowel disease: bezlotoxumab versus placebo. Gastroenterology. 2017;152(5):S340.
Lim H-W, Khan S, Sultan K. The impact of steroid use on in patients with inflammatory bowel disease and PCR diagnosed Clostridium difficile: a propensity-adjusted analysis. Gastroenterology. 2017;152(5):S579.
Meehan AM, Khanna S, Pardi DS. Outcomes in patients with recurrent Clostridium Difficile infection treated with vancomycin taper. Gastroenterology. 2017;152(5):S348.
Nelson RL, Suda KJ, Evans CT. Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults. Cochrane Database Syst Rev. 2017;3:CD004610. doi: 10.1002/14651858.CD004610.pub5.
Spiceland CM, Khanna S, Pardi DS. Outcomes with fidaxomicin therapy in Clostridium difficile infection. J Clin Gastroenterol. 2016 Dec 22. doi: 10.1097/MCG.0000000000000769.
Stevens VW, Nelson RE, Schwab-Daugherty EM, et al. Comparative effectiveness of vancomycin and metronidazole for the prevention of recurrence and death in patients with Clostridium difficile infection. JAMA Intern Med. 2017;177(4):546-553. doi: 10.1001/jamainternmed.2016.9045.
Surawicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013;108(4):478-98. doi: 10.1038/ajg.2013.4.
Van Hise NW, Bryant AM, Hennessey EK, et al. Efficacy of oral vancomycin in preventing recurrent Clostridium difficile infection in patients treated with systemic antimicrobial agents. Clin Infect Dis. 2016;63(5):651-3. doi: 10.1093/cid/ciw401.
Wilcox MH, Gerding DN, Poxton IR, et al. Bezlotoxumab for prevention of recurrent clostridium difficile infection. N Engl J Med. 2017;376(4):305-317. doi: 10.1056/NEJMoa1602615.
Yacyshyn B, Rahav G, Kao DH, et al. Efficacy of bezlotoxumab in patients with recurrent Clostridium Difficile Infection (CDI): pooled analysis of data from the MODIFY trials. Gastroenterology. 2017;152(5);S343.

Patient Resources

American College of Gastroenterology Patient Education & Resource Center. Available at: http://patients.gi.org/topics/c-difficile-infection/
Centers for Disease Control and Prevention. Frequently Asked Questions About C. difficile. Available at: https://www.cdc.gov/hai/pdfs/cdiff/cdif_largertext.pdf
Peggy Lillis Foundation. Available at: http://peggyfoundation.org/.
The C Diff Foundation. https://cdifffoundation.org/.

Overview

Faculty

David Binion, MD

Paul Feuerstadt, MD, FACG

CME/CE information

Resources

Clinician Resources

Patient Resources