Recurrent C. difficile Infection: Expert Perspectives on Impacting Clinical Outcomes and Economics - 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 recurrent CDI to reduce its burden and improve clinical outcomes.

Learning Objectives

Upon completion of this curriculum, participants will be able to:
• Identify patients who may be at increased risk for recurrent C. diff infection
• Assess the clinical efficacy and safety of biologics for prevention of recurrent CDI
• Outline evidence-based approaches for the management of first, second, and third recurrences of C. diff in diverse patient populations

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: June 30, 2017
Expiration date: June 30, 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 an y commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of this 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

James Lewis, II, PharmD (Faculty)

Consulting Agreements: Accelerate Diagnostics, Achaogen, The Medicines Company, Merck & Company, and Shionogi

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

Cheng D, Anderson A, Ramos-Rivers C, et al. The lasting impact of Clostridium difficile infection in inflammatory bowel disease: A propensity score matched analysis. Inflamm Bowel Dis. In press
Chilton CH, Crowther GS, Ashwin H, Longshaw CM, Wilcox MH. Association of fidaxomicin with C. difficile spores: effects of persistence on subsequent spore recovery, outgrowth and toxin production. PLoS One. 2016;11(8):e0161200. doi: 10.1371/journal.pone.0161200. eCollection 2016.
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.
Debast SB, Bauer MP, Kuijper EJ, et al. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2014;20 Suppl 2:1-26. doi: 10.1111/1469-0691.12418.
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. doi: 10.1053/j.gastro.2008.12.038
Kyne L, Warny M, Qamar A, Kelly CP. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet. 2001;357(9251):189-93.
Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372(9):825-34. doi: 10.1056/NEJMoa1408913.
Louie TJ, Miller MA, Mullane KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011;364(5):422-31. doi: 10.1056/NEJMoa0910812.
McFarland LV, Elmer GW, Surawicz CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol. 2002;97(7):1769-75.
Pepin J, Alary ME, Valiquette L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005;40(11):1591-7.
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.
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.
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.

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

James Lewis, II, PharmD, FIDSA

CME/CE information

Resources

Clinician Resources

Patient Resources