Management of Initial and Recurrent <em>Clostridium difficile</em> Infection: Progress and Promise of Novel Pathways

Release Date: Tuesday, November 24, 2015 Expiration Date: Wednesday, November 24, 2016

Educational Overview

Clostridium difficile infection (CDI) places a significant clinical and economic burden on the healthcare system. The increased morbidity and mortality associated with CDI is at least partially attributed to the spread of a hypervirulent strain known for its increased toxin production. Research findings have provided a better understanding of CDI pathogenesis, including the role of intestinal dysbiosis and host immune response on short- and long-term patient outcomes. This has allowed clinicians to identify host factors that can be used to predict clinical outcomes, thereby guiding appropriate management strategies to resolve the infectious episode and minimize the risk for recurrence or serious complications.

In the past, treatment has mainly been limited to antimicrobial therapy with vancomycin or metronidazole. Fortunately, new and emerging options can provide clinicians with an array of tools necessary to improve patient outcomes. These include potent narrow-spectrum antimicrobials that limit dysbiosis, as well as non-traditional therapeutic entities, such as fecal microbiota transplantation and monoclonal antibodies. The successful management of CDI involves efforts from all medical disciplines who are responsible for the care of patients with or at risk of infection. Infectious disease specialists can play a major role in ensuring that appropriate measures are in place to initiate appropriate and timely treatment to eradicate the infection and prevent recurrence.

Throughout this symposium, an interactive patient case scenario will be utilized to reflect the challenges and decision-making process that occur regularly in clinical practice at various stages of disease for patients with CDI.

Target Audience

This continuing medical education activity is planned to meet the need of healthcare providers in a variety of practice settings, including large and small health systems, outpatient clinics, managed-care organizations, long-term care facilities, and academia. This activity is especially beneficial for ID physicians and pharmacists who are on the frontline of managing patients with CDI.

Learning Objectives

Upon completing this activity, participants will be able to:

Discuss the interaction between bacteria and host involved in the pathogenesis of Clostridium difficile infection (CDI)
Utilize prediction tools that identify pathogen and host factors that contribute to poor clinical outcomes among patients with CDI as a means to guide management approaches
Evaluate the role of traditional antimicrobials and newer therapeutic approaches for the treatment of CDI and the prevention of recurrent infection

Educational Format

These Online Presentations are based on the CME/CPE Satellite Symposium held following IDWeek 2015.

Please Note: If you have received credit for attending the live symposium by the same name, you are not eligible to apply for credit for this online version.

This online activity is divided into five portable and easy to access episodes:

Episode 1: Epidemiological Trends in the Healthcare
and Community Settings
Stuart J. Johnson, MD

Episode 2: New Perspectives on CDI Pathogenesis and
How this Translates to Therapy
Ciarán P. Kelly, MD

Episode 3: Recognizing Factors Associated with
Poor Clinical Outcomes in CDI
Erik R. Dubberke, MD, MSPH

Episode 4: Integrating the New with the Old when
Managing CDI
Stuart J. Johnson, MD

Episode 5: Useful Q and A

Faculty

	Erik R. Dubberke, MD, MSPH, FSHEA Associate Professor of Medicine Director, Section of Transplant Infectious Diseases Washington University School of Medicine St. Louis, MO

	Stuart J. Johnson, MD Professor, Department of Medicine Stritch School of Medicine Loyola University Chicago, IL

	Ciarán P. Kelly, MD Professor of Medicine  Harvard Medical School  Director Gastroenterology Fellowship Training  Director Celiac Center  Beth Israel Deaconess Medical Center  Boston, MA

Accreditation
Physicians
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the Center for Independent Healthcare Education and Vemco MedEd, LLC. Center for Independent Healthcare Education (Center) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Center for Independent Healthcare Education designates this Enduring material for a maximum of 2.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

International CME
International Physicians are formally eligible for AMA PRA Category 1 Credit™.

Physician Assistants
AAPA accepts AMA PRA Category 1 Credit™ for the PRA from organizations accredited by ACCME.

Nurse Practitioners
Nurse Practitioners will receive certificate of AMA PRA Category 1 Credit™ as this is an ACCME accredited program and its accreditation is recognized by Nurse Practitioner boards

Pharmacists
Center for Independent Healthcare Education is accredited by the Accreditation Council for Pharmacy Education as a provider for continuing pharmacy education. Center has assigned 2.0 contact hours (0.2 CEUs) of continuing pharmacy education credits for participating in this activity.

ACPE UAN: UAN: 0473-9999-15-006-H01-P
Activity type: Application-based

For questions regarding the accreditation of this activity, please contact us at info@jointsponsor.com

Method of Participation and Instruction for Credit

Review the entire CME/CPE information including target audience, learning objectives, and disclosures.
Review each episode.
Complete the Online Post Test, Evaluation, and Credit Application form
Please note that to receive credit you must achieve a score of at least 70%.
Physicians: Certificate of Credit will be emailed within 4 weeks of successful completion of the activity.
Pharmacists: The information that you participated will be uploaded to CPE Monitor and you will be able to access your credits from the profile you set up with NABP. For more information, please visit http://www.nabp.net/

For questions regarding accreditation, please contact info@jointsponsor.com

Disclosure of Conflicts of Interest
In accordance with policies set forth by the Accreditation Council for Continuing Medical Education (ACCME), Center for Independent Healthcare Education requires all faculty members and spouses/significant others with an opportunity to affect the content of a continuing education activity to disclose any relevant financial relationships during the past 12 months with commercial interests. A commercial interest is any entity producing, marketing, reselling or distributing health care goods or services consumed by or used on patients. Relationships with commercial interests and conflicts of interest resulting from those relationships must be revealed to the audience and resolved prior to the activity

Relevant relationships include roles such as speaker, author, consultant, independent contractor (including research), employee, investor, advisory committee member, board member, review panelist, and investigator. If a potential speaker or author indicates a possible conflict of interest, the conflict will be resolved by choosing another speaker or author for that topical area, or the slides, handouts, and/or monograph will be reviewed and approved by a qualified commercially-disinterested peer.

Disclosures
Erik R. Dubberke, MD has relevant financial relationships with the following commercial interests:
     Advisory Board: Theravance
     Consultant: Pfizer, Merck, Rebiotix, Sanofi-Pasteur, Daiichi
     Grant Recipient/Research Support: Sanofi-Pasteur, Merck, Rebiotix, Microdermis
Dr. Dubberke does not discuss off-label uses of any products.

Stuart J. Johnson, MD has relevant financial relationships with the following commercial interests:
     Advisory Board: BioK+

Dr. Johnson discusses the off-label use of following:

• Metronidazole (it was never FDA approved for CDI* but it is one of the most
common treatments for CDI and included in all guideline recommendations)

     • Rifaximin (FDA-approved for treatment of non-inflammatory traveler’s diarrhea,
       not CDI): It has been studied as a post-vancomycin ‘chaser’ treatment strategy
       for patients with multiple recurrences. I will clearly indicate that it is not FDA-approved
       for CDI but this is the setting in which it has been studied

     • Fidaxomicin (FDA-approved for CDI) I will mention novel strategies for fidaxomicin
       in patients with multiple CDI recurrences such as post-vancomycin ‘chaser’ and
       ‘extended duration/ taper’ regimens. I will clearly indicate that these regimens are not
       on the FDA-approved product insert but are potential strategies for patients with
       multiple CDI recurrences who do not respond to standard dosing recommendations
       for CDI

• I will briefly mention other CDI treatment options that are available but not FDA-
approved: Nitazoxanide and Fecal Microbiota Transplant (FMT)

Ciarán P. Kelly, MD has relevant financial relationships with the following commercial interests:
      Advisory Board/Consultant: Cubist, MedImmune, Merck, Openbiome, Sanofi-
                                                    Pasteur, Seres Health, Synthetic Biologics
      Grant Recipient/Research: Claremont BioSolutions, Merck
      Speaker: Cubist, Merck

Dr. Kelly discusses the off-label uses of following:

• Metronidazole; Bezlotoxumab; Seres 109; IVIG; C. difficile toxoid vaccine; Actoxumab;
FMT (stool transplant); non-toxigenic C. difficile (NTCD)

No (other) speakers, authors, planners or content reviewers have any relevant financial relationships to disclose. No (other) speakers or authors will discuss off-label use of a product.

Content review confirmed that the content was developed in a fair, balanced manner free from commercial bias. Disclosure of a relationship is not intended to suggest or condone commercial bias in any presentation, but it is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Fee
There is no fee to participate in this activity.

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Joint Providership
This activity is jointly provided by Center for Independent Healthcare Education
and Vemco MedEd.

Commercial Support

This activity is supported by an educational grant from Merck & Co., Inc.

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