An Update on the 2017 IDSA/SHEA Clinical Practice Guidelines: Focus on the Identification and Treatment of Recurrent C. difficile - 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 recurrent 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 activity, participants will be able to:
• Outline risk factors for recurrent C. difficile infection to consider when selecting treatment
• Discuss available data on the treatment of recurrent C. difficile and how that data was applied to the updated IDSA/SHEA Clinical Practice Guidelines
• Compare and contrast recommendations from the 2017 IDSA/SHEA guidelines with previous versions and recommendations from other organizations

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 a post-test and evaluation form. 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: March 16, 2018
Expiration date: March 16, 2019

Inquiries may be directed to ACHL at (877) 444-8435, ext. 228.

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:

Paul Feuerstadt, MD, FACG

Consulting Agreements: Merck & Company
Speakers' Bureau: RedHill Biopharma, Allergan, and Merck & Company

Discussion of Off-Label, Investigational, or Experimental Drug/Device Use: Use of agents not approved 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 for 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

Chang JY, Antonopoulos DA, Kalra A, et al. Decreased diversity of the fecal microbiome in recurrent Clostridium difficile-associated diarrhea. J Infect Dis. 2008;197(3):435-8. doi: 10.1086/525047.
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.
Cornely OA, Miller MA, Louie TJ, et al. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clin Infect Dis. 2012;55 Suppl 2:S154-61.
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.
Deshpande A, Pasupuleti V, Thota P, et al. Risk factors for recurrent Clostridium difficile infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2015;36(4):452-60. doi: 10.1017/ice.2014.88.
Drekonja DM, Amundson WH, Decarolis DD, et al. Antimicrobial use and risk for recurrent Clostridium difficile infection. Am J Med. 2011;124(11):1081.e1-7. doi: 10.1016/j.amjmed.2011.05.032.
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.
Garey KW, Jiang ZD, Bellard A, Dupont HL. Rifaximin in treatment of recurrent Clostridium difficile-associated diarrhea: an uncontrolled pilot study. J Clin Gastroenterol. 2009;43(1):91-3. doi: 10.1097/MCG.0b013e31814a4e97.
Goldenberg SD, Brown S, Edwards L, et al. The impact of the introduction of fidaxomicin on the management of Clostridium difficile infection in seven NHS secondary care hospitals in England: a series of local service evaluations. Eur J Clin Microbiol Infect Dis. 2016;35(2):251-9. doi: 10.1007/s10096-015-2538-z.
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.
Johnson S, Schriever C, Galang M, Kelly CP, Gerding DN. Interruption of recurrent Clostridium difficile-associated diarrhea episodes by serial therapy with vancomycin and rifaximin. Clin Infect Dis. 2007;44(6):846-8.
Ma GK, Brensinger CM, Wu Q, Lewis JD. Increasing incidence of multiply recurrent Clostridium difficile infection in the United States: a cohort study. Ann Intern Med. 2017;167(3):152-158. doi: 10.7326/M16-2733. Epub 2017 Jul 4.
McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Feb 15. doi: 10.1093/cid/cix1085. [Epub ahead of print].
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.
Meehan AM, Khanna S, Pardi DS. Outcomes in patients with recurrent Clostridium difficile infection treated with vancomycin taper. Gastroenterology. 2017;152(Suppl 1):S348.
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. Epub 2005 Apr 25.
Sirbu BD, Soriano MM, Manzo C, et al. Vancomycin taper and pulse regimen with careful follow-up for patients with recurrent Clostridium difficile infection. Clin Infect Dis. 2017;65(8):1396-1399. doi: 10.1093/cid/cix529.
Soriano MM, Danziger LH, Gerding DN, Johnson S. Novel fidaxomicin treatment regimens for patients with multiple Clostridium difficile infection recurrences that are refractory to standard therapies. Open Forum Infect Dis. 2014;1(2):ofu069. doi: 10.1093/ofid/ofu069.
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.
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(Suppl 1): S343.
Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007;45(3):302-7.

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

Paul Feuerstadt, MD, FACG

CME/CE information

Resources

Clinician Resources

Patient Resources