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


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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.


  • 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


    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


  • Alessia Piazza, PhD

    Medical Education Director, WebMD Global, LLC


    Alessia Piazza, PhD, has no relevant financial relationships.

  • Ashley Stumvoll, MRes

    Associate Medical Writer, WebMD Global, LLC


    Ashley Stumvoll, MRes, has no relevant financial relationships.

Compliance Reviewer

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance


    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


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.

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

Authors: Mark H. Wilcox, MD Faculty and Disclosures

CME Released: 11/23/2022

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



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  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.
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  24. Lee JC, et al. Severe Clostridium difficile infections in intensive care units: diverse clinical presentations. J Microbiol Immunol Infect. 2021;54:1111-1117.
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  26. Louie TJ, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011;364:422-431.
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  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.
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  34. Martinez FJ, et al. Clostridium difficile outbreaks: prevention and treatment strategies. Risk Manag Healthc Policy. 2012;5:55-64.
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  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.
  47. Poduval RD, et al. Clostridium difficile and vancomycin-resistant Enterococcus: the new nosocomial alliance. Am J Gastroenterol. 2000;95:3513-3515.
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  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.
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