C. difficile infection (CDI) is a leading cause of hospital-acquired infections (HAIs) and mortality in the US. A recent report from the Centers for Disease Control and Prevention showed that, though there was a 16% reduction in HAIs from 2011 to 2015, there was no substantial decline in the incidence of CDI. The CDC has recognized C. difficile infection as an urgent public health threat and emphasizes the importance of continued efforts in prevention of these infections. The emergence of the BI/NAP1/027 hypervirulent strain has resulted in greater morbidity and mortality and a high likelihood of recurrence. Approximately 25% of patients with a first CDI episode will experience a recurrent episode, and the recurrence rate increases with each subsequent recurrence. As such, CDI continues to present numerous challenges to clinicians in controlling the clinical and economic burden of these infections.

The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) released their highly-anticipated update of the C. difficile clinical practice guidelines in February 2018. Since the release of the previous guidelines in 2010, several advancements in diagnosis, treatment, and prevention of recurrence have been made that are addressed in the new guidelines. Hospital-based clinicians involved in the prevention and management of CDI must be made aware of the latest evidence-based recommendations. However, the guidelines only provide a basic model for clinicians when making management decisions. The guidelines also do not include the latest clinical evidence on the use of immunotherapy in the prevention of recurrent CDI episodes. Further practical guidance is needed to assist clinicians in translating the guideline recommendations into clinical practice behavior in order to optimize outcomes based on clinical setting, underlying disease, patient type, and risk factors for severe or recurrent infection. The release of the updated guidelines now provides an ideal opportunity to raise awareness of the burden and consequences of CDI, as well as educate clinicians on the latest approaches to optimize prevention and management strategies.

As a key patient advocate in acute care settings, the hospitalist plays a major role in ensuring that appropriate measures are in place for their patients with or at risk for C. difficile infection (CDI). Hospitalists not only ensure that appropriate preventive and diagnostic measures are performed, but they are an invaluable member of the interprofessional healthcare team involved in clinical decision-making. Therefore, hospitalists must be fully aware of the latest IDSA/SHEA clinical management guidelines and recognize how to translate these recommendations into clinical practice. This activity will review the evidence supporting the guideline recommendations on treatment of initial and recurrent episodes of CDI as well as appraise the latest approaches aimed at minimizing the risk of CDI recurrence. These approaches can include assessing patient risk, appropriate antimicrobial selection, optimized dosing regimens, and the use of immunotherapy.

TARGET AUDIENCE

Optimal management of CDI requires contributions from all HCPs, including hospitalists, involved in the management of patients at risk for these infections. Therefore, this program targets hospitalists who play a role in managing and preventing infections at healthcare institutions.

LEARNING OBJECTIVES

Upon completing this activity, participants will be able to:

• List patient factors that increase the risk for C. difficile infection and recurrence
• Apply the latest evidence-based guideline recommendations when selecting appropriate treatment for an initial or recurrent episode of C. difficile infection
• Evaluate the latest therapeutic approaches to prevent
  C. difficile infection recurrence

ADDITIONAL RESOURCES

Please click here to view the updated IDSA CDI Guidelines

EDUCATIONAL FORMAT

This Online Presentation is based on the Satellite Symposium presented at Hospital Medicine 2019. It is divided into 4 easy and quick to view episodes.

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

FACULTY

	William T. Ford, MD, SFHM Regional Director Hospital Medicine Clinical Associate Professor of Medicine Abbington Jefferson Health Abbington, PA
	Jason C. Gallagher, PharmD, FCCP, FIDP, FIDSA, BCPS Clinical Professor Clinical Specialist, Infectious Diseases Director, PGY2 Residency in Infectious Diseases Pharmacy Temple University Philadelphia, PA
	Ciarán P. Kelly, MD Professor of Medicine Harvard Medical School Director Gastroenterology Fellowship Training Director Celiac Center Beth Israel Deaconess Medical Center Boston, MA