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      Friday, December 1, 2023
      News & Perspective Drugs & Diseases CME & Education Academy Video Decision Point
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      CME

      Best Practice in First-Line Management of Clostridioides difficile: Practical Patient Cases and Expert Perspectives

      • Authors: Mark H. Wilcox, MD 
      • CME Released: 11/23/2022
      • THIS ACTIVITY HAS EXPIRED FOR CREDIT
      • Valid for credit through: 11/23/2023, 11:59 PM EST
      Start Activity

      Target Audience and Goal Statement

      This educational activity is intended for an international audience of non-US gastroenterologists, infectious disease specialists, and primary care physicians.

      The goal of this activity is for learners to be better able to optimize first-line management of patients with C difficile.

      Upon completion of this activity, participants will:

      • Have increased knowledge regarding the
        • Evidence-based strategies for diagnosing C difficile
      • Have greater competence related to
        • Optimizing treatment selection for C difficile
        • Using antimicrobial stewardship approaches in management of C difficile

      Disclosures

      Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

      All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.

      Faculty

      • Mark H. Wilcox, MD

        Professor of Medical Microbiology
        Sir Edward Brotherton Chair of Bacteriology
        University of Leeds
        Leeds Teaching Hospitals NHS Trust
        Leeds, United Kingdom

        Disclosures

        Mark H. Wilcox, MD, has the following relevant financial relationships:
        Consultant or advisor for: Bayer; Crestone; Da Volterra; Deinove; EnteroBiotix; Ferring; GlaxoSmithKline; Merck; Nestlé; Paion; Paratek; Pfizer; Phico Therapeutics; Qpex Biopharma; Seres; Surface Skins; Summit; Tillotts; Vedanta; Vaxxilon/Idorsia
        Speaker or member of speakers bureau for: GlaxoSmithKline; Merck; Pfizer; Seres
        Research funding from: Almirall; Da Volterra; EnteroBiotix; GlaxoSmithKline; Merck; MicroPharm; Nabriva; Paratek; Pfizer; Seres; Summit; Tillotts
        Stock options from: Seres

      Editors

      • Alessia Piazza, PhD

        Medical Education Director, WebMD Global, LLC

        Disclosures

        Alessia Piazza, PhD, has no relevant financial relationships.

      • Ashley Stumvoll, MRes

        Associate Medical Writer, WebMD Global, LLC

        Disclosures

        Ashley Stumvoll, MRes, has no relevant financial relationships.

      Compliance Reviewer

      • Leigh Schmidt, MSN, RN, CNE, CHCP

        Associate Director, Accreditation and Compliance

        Disclosures

        Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

      Peer Reviewer

      This activity has been peer reviewed and the reviewer has no relevant financial relationships.

      Accreditation Statements

      Medscape

      Interprofessional Continuing Education

      In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

        For Physicians

      • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

        Contact This Provider

      For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

      Instructions for Participation and Credit

      There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

      This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

      Follow these steps to earn CME/CE credit*:

      1. Read the target audience, learning objectives, and author disclosures.
      2. Study the educational content online or printed out.
      3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

      You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

      *The credit that you receive is based on your user profile.

      From Medscape Education
      CME

      Best Practice in First-Line Management of Clostridioides difficile: Practical Patient Cases and Expert Perspectives

      Authors: Mark H. Wilcox, MD Faculty and Disclosures
      THIS ACTIVITY HAS EXPIRED FOR CREDIT

      CME Released: 11/23/2022

      Valid for credit through: 11/23/2023, 11:59 PM EST

      processing....

      References

      1. Balsells E, et al. Global burden of Clostridium difficile infections: a systematic review and meta-analysis. J Glob Health. 2019;9:010407.
      2. Viprey VF, et al. A point-prevalence study on community and inpatient Clostridioides difficile infections (CDI): results from Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI), July to November 2018. Eurosurveillance. 2022;27:2100704.
      3. Madden GR, et al. Validation of clinical risk models for Clostridioides difficile-attributable outcomes. Antimicrob Agents Chemother. 2022;66:e00676-22.
      4. Eze P, et al. Risk factors for Clostridium difficile infections – an overview of the evidence base and challenges in data synthesis. J Glob Health. 2017;7:010417.
      5. Rupnik M. Is Clostridium difficile-associated infection a potentially zoonotic and foodborne disease? Clin Microbiol Infec. 2007;13:457-459.
      6. Kachrimanidou M et al. Clostridioides (Clostridium) difficile in food-producing animals, horses and household pets: a comprehensive review. Microorganisms. 2019;7:667.
      7. Fatima R, et al. The Hypervirulent strain of Clostridium difficile: NAP1/B1/027 - a brief overview. Cureus. 2019;11:e3977.
      8. Jangi S, et al. Asymptomatic colonization by Clostridium difficile in infants: implications for disease in later life. J Pediatr Gastr Nutr. 2010;51:2-7.
      9. Longo DL, et al. Clostridium difficile infection. N Engl J Med. 2015;372:1539-1548.
      10. Khanna S, et al. Transitions of care in Clostridioides difficile infection: a need of the hour. Ther Adv Gastroenter. 2022;15:17562848221078684.
      11. Kelly CR, et al. Am J Gastroenterol. 2021;116:1124-1147.
      12. Johnson S, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clin Infect Dis. 2021;73:ciab549-.
      13. van Prehn J, et al. European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults. Clin Microbiol Infec. 2021;27:S1-S21.
      14. Pépin J, et al. Mortality attributable to nosocomial Clostridium difficile–associated disease during an epidemic caused by a hypervirulent strain in Quebec. Can Med Assoc J. 2005;173:1037-1042.
      15. Jones J, et al. Is three company or a crowd? Comparing and contrasting U.S. and European Clostridioides difficile clinical practice guidelines. Antibiotics. 2022;11:1247.
      16. Carroll K, et al. Laboratory tests for the diagnosis of Clostridium difficile. Clin Colon Rect Surg. 2020;33:73-81.
      17. McDonald LC, 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;66:e1-e48.
      18. Christensen AB, et al. Diagnostic stewardship of C. difficile testing: a quasi-experimental antimicrobial stewardship study. Infect Control Hosp Epidemiol. 2019;40:269-275.
      19. Davies KA, et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis. 2014;14:1208-1219.
      20. Xuan S, et al. Cost-effectiveness analysis of four common diagnostic methods for Clostridioides difficile Infection. J Gen Intern Med. 2020;35:1102-1110.
      21. Davies K, et al. Variability in testing policies and impact on reported Clostridium difficile infection rates: results from the pilot Longitudinal European Clostridium difficile Infection Diagnosis surveillance study (LuCID). Eur J Clin Microbiol. 2016;35:1949-1956.
      22. Czepiel J, et al. Mortality following Clostridioides difficile infection in Europe: a retrospective multicenter case-control study. Antibiotics. 2021;10:299.
      23. Kassam Z, et al. Clostridium difficile associated risk of death score (CARDS): a novel severity score to predict mortality among hospitalised patients with C. difficile infection. Aliment Pharm Therap. 2016;43:725-733.
      24. Lee JC, et al. Severe Clostridium difficile infections in intensive care units: diverse clinical presentations. J Microbiol Immunol Infect. 2021;54:1111-1117.
      25. Fidaxomicin [prescribing information]. Approved 2011. Accessed October 21, 2022.
      26. Louie TJ, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011;364:422-431.
      27. Cornely OA, et al. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clin Infect Dis. 2012;55(suppl_2):S154-S161.
      28. Ramírez ER, et al. Updates on Clostridium difficile in Europe. Adv Exp Med Biol. 2018;1050:1-12.
      29. European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC; 2013.
      30. Freeman J, et al. The changing epidemiology of Clostridium difficile infections. Clin Microbiol Rev. 2010;23:529-549.
      31. Bhattarai R, et al. Length of hospital stay and charges attributable to Clostridioides Difficile infections in Arizona, 2018. Am J Infect Control. 2020;48:S16.
      32. Zhang S, et al. Cost of hospital management of Clostridium difficile infection in United States -- a meta-analysis and modelling study. BMC Infect Dis. 2016;16:447.
      33. Roca I, et al. The global threat of antimicrobial resistance: science for intervention. New Microbes New Infect. 2015;6:22-29.
      34. Martinez FJ, et al. Clostridium difficile outbreaks: prevention and treatment strategies. Risk Manag Healthc Policy. 2012;5:55-64.
      35. Spigaglia P. Recent advances in the understanding of antibiotic resistance in Clostridium difficile infection. Ther Adv Infect Dis. 2016;3:23-42.
      36. Alm RA, et al. Narrow-spectrum antibacterial agents -- benefits and challenges. Antibiotics. 2020;9:418.
      37. Freeman J, et al. The ClosER study: results from a three-year pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes, 2011–2014. Clin Microbiol Infec. 2018;24:724-731.
      38. Freeman J, et al. Five-year Pan-European, longitudinal surveillance of Clostridium difficile ribotype prevalence and antimicrobial resistance: the extended ClosER study. Eur J Clin Microbiol. 2020;39:169-177.
      39. Kiersnowska ZM, et al. Hand hygiene as the basic method of reducing Clostridium difficile infections (CDI) in a hospital environment. Ann Agric Environ Med. 2021;18:535-540.
      40. McFarland LV, et al. Nosocomial acquisition of Clostridium difficile Infection. N Engl J Med. 1989;320:204-210.
      41. Otter JA, et al. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. Am J Infect Control. 2013;41:S6-S11.
      42. Oughton MT, et al. Hand hygiene with soap and water is superior to alcohol rub and antiseptic wipes for removal of Clostridium difficile. Infect Control Hosp Epidemio. 2009;30:939-944.
      43. Guerrero DM, et al. Acquisition of spores on gloved hands after contact with the skin of patients with Clostridium difficile infection and with environmental surfaces in their rooms. Am J Infect Control. 2012;40:556-558.
      44. Islam J et al. Influence of cohorting patients with Clostridium difficile infection on risk of symptomatic recurrence. J Hosp Infect. 2013;85:17-21.
      45. Dubberke ER, et al. Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis. 2007;45:1543-1549.
      46. Centers for Disease Control and Prevention (CDC). Strategies to prevent Clostridioides difficile infection in acute care facilities. 2021. Accessed November 2, 2022. www.cdc.gov/cdiff/clinicians/cdi-prevention-strategies.html
      47. Poduval RD, et al. Clostridium difficile and vancomycin-resistant Enterococcus: the new nosocomial alliance. Am J Gastroenterol. 2000;95:3513-3515.
      48. Brasg I, et al. Predictive utility of swab screening for vancomycin-resistant Enterococcus in selection of empiric antibiotics for Enterococcus sterile-site infections: a retrospective cohort study. CMAJ Open. 2017;5:E632-E637.
      49. Goić-Barišić I, et al. Vancomycin-resistant Enterococcus faecium COLONIZATION and Clostridium difficile infection in a hematologic patient. Acta Clin Croat. 2020;59:523-528.
      50. Rafferty ME, et al. Vancomycin-resistant enterococci in stool specimens submitted for Clostridium difficile cytotoxin assay. Infect Control Hosp Epidemiol. 1997 May;18:342-4.
      51. Eubank TA, et al. Genetic mechanisms of vancomycin resistance in Clostridioides difficile: a systematic review. Antibiotics. 2022;11:258.
      52. Özsoy S et al. Detection of vancomycin-resistant enterococci (VRE) in stool specimens submitted for Clostridium difficile toxin testing. Braz J Microbiol. 2017;48:489-492.
      53. Eckstein BC, et al. Reduction of Clostridium difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis. 2007;7:61.
      54. Barlam TF, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62:e51-e77.
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