Tag Archives: Cdiff treatments

Severe Cases of C.diff. Infection (CDI)Study Suggests the Most Routinely Prescribed Antibiotic Is Not the Best Treatment

Pill-bottles

Over the past two decades there has been a sharp rise in the number and severity of infections caused by the bacteria Clostridium difficile  (C. diff ) now the most common healthcare-acquired infection in the United States.

 

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But a new study suggests that the most routinely prescribed antibiotic is not the best treatment for severe cases. Scientists at the VA Salt Lake City Health Care System and University of Utah report that patients with a severe C. diff infection (CDI) were less likely to die when treated with the antibiotic vancomycin compared to the standard treatment of metronidazole.

The findings will be published online on Feb. 6, 2017 on the Journal of the American Medical Association (JAMA) Internal Medicine website.

C. diff does not cause illness outright. The bacterium produces two chemicals that are toxic to the human body. These toxins work in concert to irritate the cells of the Large intestinal lining producing the symptoms associated with the illness. Symptoms of CDI include watery diarrhea, fever, loss of appetite, nausea, and abdominal pain and tenderness. Severe cases are associated with inflammation of the colon.

Current guidelines primarily recommend two antibiotics metronidazole or vancomycin to treat CDI. While vancomycin was the original treatment, the medical community has favored metronidazole for the past few decades, because it is less expensive and will limit vancomycin resistance in other hospital-acquired infections. The guidelines are based on small clinical trials carried out about 30 years ago.

“For many years the two antibiotics were considered to be equivalent in their ability to cure C. diff and prevent recurrent disease,” says Stevens. “Our work and several other studies show that this isn’t always the case.” In the current issue of JAMA Internal Medicine, the research team looked at the effectiveness of the two drugs by comparing the risk of mortality after treatment with these two antibiotics.

The investigators conducted the largest study to date by examining the data from more than 10,000 patients treated for CDI through the US Department of Veterans Affairs healthcare system from 2005 to 2012. A severe case of CDI was defined as a patient with an elevated white blood cell count or serum creatinine within four days of the CDI diagnosis. A mild to moderate case of CDI was defined as a patient with normal white blood cell counts and creatinine levels. About 35 percent of cases in this study were considered severe.

Patients with a severe case of CDI had lower mortality rates when treated with vancomycin compared to metronidazole (15.3 percent versus 19.8 percent). The scientists calculated that only 25 patients with severe CDI would need to be treated with vancomycin to prevent one death. “That is a powerful, positive outcome for our patient’s well-being,” explains Stevens. She cautions that the researchers still do not understand how the choice of antibiotic affects mortality rates.

“Although antibiotics are one of the greatest miracles of modern medicine, there are still tremendous gaps in our knowledge about when and how to use them to give our patients the best health outcomes,” explains Michael Rubin, M.D., Ph.D., an associate professor in internal medicine and an investigator at the VA Salt Lake City Health Care System.

“This research shows that if providers choose vancomycin over metronidazole to treat patients with severe CDI, it should result in a lower risk of death for those critically ill patients,” said Rubin. This study showed that less than 15 percent of CDI patients, including severe cases, received vancomycin.

The study results did not show a difference in the rate of the illness returning following either antibiotic treatment whether the initial illness was mild to moderate or severe. Nor did it show a difference for the rate of death following either antibiotic treatment for mild to moderate CDI cases.

Stevens cautions that the study was observational in nature and does not prove cause and effect of the drug. In addition, the study focused on patients that were primarily men; however, past studies show that the C. diff treatment outcomes for men and women were similar.

According to Stevens, future work should balance the targeted application of vancomycin treatment, especially for severe CDI cases, with economic considerations and the consequences of antibiotic resistance. “The optimal way to move forward is to do decision analysis that allows us to weigh the pros and cons of the various treatment strategies,” she says.

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The research was funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development.

In addition to Stevens and Rubin, co-authors include Richard Nelson, Karim Khader, Makoto Jones, Lindsay Croft and Matthew Samore (University of Utah and the VA Salt Lake City Health Care System), Elyse Schwab-Daugherty and Kevin A. Brown (Public Health Ontario and University of Toronto), Tom Greene (University of Utah), Melinda Neuhauser (VA Pharmacy Benefits Management Services) and Peter Glassman and Matthew Bidwell Goetz (VA Greater Los Angeles Healthcare System).

Highlights Of the Latest Advances In the Battle Against the Deadly Pathogen – Dale Gerding, MD

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In September, researchers, health care workers, and industry and patient advocates convened for the 4th Annual International Raising C. diff Awareness Conference and Health Expo in Atlanta.

Clifford McDonald, MD, Associate Director for Science in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC), chaired the conference. In his role at the CDC, McDonald’s at the forefront of efforts to prevent and treat the infection – one the CDC has declared among the most urgent drug-resistant threats that we currently face.

“It’s my firm belief that we are on the threshold of a new era in better diagnosis, treatment, and prevention approaches. At the CDC, we deal with statistics, but there are faces behind those numbers. At the heart of every infection is a patient who deserves our competence, our empathy, and our passion,” said McDonald.

One of those faces, Roy Poole, is a volunteer patient advocate for the  C Diff Foundation. After retiring from a career in the Air Force, Poole led a healthy, active lifestyle as an avid outdoors-man in Colorado before antibiotics prescribed for a routine dental procedure set the stage for CDI. In the medical community, his symptoms were met with disbelief and inappropriate treatment.

“Three weeks after leaving the hospital, I walked into my (previous) primary care physician, and asked for an order to have a stool sample taken to determine if Toxins A or B were present. His response was, ‘Are you still having problems with that?’ Clearly, there is a need for more education about C. diff among physicians,” said Poole.

CDI is a formidable opponent. However, with the newly focused attention on discovering ways to disable the bacteria and cohesive public health approaches aimed at prevention, presenters from government, academia and industry offered five key reasons we can win the battle against C. diff:

Antibiotic stewardship efforts are gaining a foothold.
Statistics present a chilling picture: 453,000 new cases and an estimated 30,000 deaths each year. It’s likely that those numbers grossly underestimate the true impact of CDI, since it’s what we know from death certificate reporting.

However, we are seeing that rates may have peaked after a long plateau. Mark Wilcox, MD, Head of Microbiology at Leeds Teaching Hospital, Professor of Medical Microbiology at University of Leeds, and the lead on Clostridium difficile for Public Health England in the United Kingdom, has demonstrated a 70% reduction in cases in England in just 7 years. This was after a concerted effort that Wilcox spearheaded surrounding antibiotic stewardship, specifically addressing a reduction in unnecessary prescribing of fluoroquinolones and cephalosporin antibiotics.

Commonly prescribed antibiotics disrupt the protective microbiota (the normal bacteria of the gut) and leave it vulnerable for C. diff colonization. “There was a concerted effort that went beyond lip service and truly embraced the principles of improved surveillance, more accurate diagnostics, enhanced infection prevention measures to use antibiotics more wisely and to limit transmission and careful treatment,” said Wilcox.

High rates of CDI are always associated with the use of certain antibiotics: clindamycin, cephalosporin, and fluoroquinolones. Research has shown that lower respiratory tract infections and urinary tract infections account for more than 50% of all in-patient antibiotics use. But are these really necessary?

“We know that antibiotics are overused and misused across every healthcare setting. At least 30% of antibiotic prescriptions are unnecessary – and this equates to 47 million unnecessary antibiotic prescriptions per year written in doctors’ offices, hospital outpatient departments, and emergency departments. We have a lot of work to do, and CDC is actively working to reduce unnecessary antibiotic use,” said Arjun Srinivasan, MD at the CDC. “Stopping unnecessary antibiotics is the single most effective thing we can do to curb C. diff infections in the United States. This is something that we can do today.”

Srinivasan acknowledged that telling patients that they can’t have a prescription for an antibiotic might result in some pushback. “Patient satisfaction scores are a very real concern. When someone is sick and takes a day off work, they’re not leaving without a prescription – especially when the last provider wrote one for their same symptoms,” he said. “But this is a new day, and it’s up to the physician to educate their patients and stay strong.”

Hospitalists have access to accurate, inexpensive and quick diagnostic tests that can lead to targeted, effective treatment. This can arm the treating physician and patient with information that can put patients on a path to recovery without feeling like they are being dismissed.

Emerging guidance reflects important advances in research and development.

Most recently published in 2010, the Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for C. diff are currently under review. This is critical because of the number of physicians still treating with metronidazole first, despite the fact that the largest randomized controlled clinical trial has shown that vancomycin is more effective.

“Since 2010, the landscape has changed dramatically,” said Stuart B. Johnson, MD, Professor, Department of Medicine, Loyola University, and Researcher at the Hines VA Hospital in Chicago.

“The past few years have ushered in a new age of understanding how and where C. diff colonizes, and the damaging toxins A and B that it produces.”

Considering that 25-30% of patients experience a CDI recurrence, it’s evident that metronidazole unnecessarily contributes to the failed treatment outcomes for patients. Metronidazole is less expensive, but has more side effects than oral vancomycin and is less effective in treating CDI.

Johnson provided an overview of the dramatic advances this space has seen in just the past few years.

Limitations of current guidelines include:
•       No mention of fidaxomicin, a narrow-spectrum antibiotic, which in 2011 was the first medication approved in 25 years for the treatment of C. diff associated diarrhea
•       Limited evidence for recommendations to treat severe, complicated CDI
•       Limited evidence for recommendations on recurrent CDI
•       Little mention of Fecal Microbiota Transplant (FMT)

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5.  Patient advocacy and awareness efforts can alter the course of CDI.
CDI survivors shared their experiences along their emotional journey – fear, disbelief, isolation, and depression. They also expressed gratitude at the validation, information and support they received from the patient advocacy community. Perhaps the greatest gift they have received is the empowerment to question their physicians about the necessity of antibiotics they have been prescribed in terms of risk of CDI.

“The hospital where I was treated initially seemed eager to have me leave. They offered no additional help. The C diff Foundation has been my greatest source of help. In turn, I feel I help myself cope best, when I help others to cope with the disease,” said Poole.

TO READ THIS ARTICLE IN ITS ENTIRETY AS PUBLISHED IN THE MD MAGAZINE 

PLEASE CLICK ON THE FOLLOWING LINK TO BE REDIRECTED —- THANK YOU

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Dale Gerding, MD, FACP, FIDSA, is Professor of Medicine at Loyola University Chicago, Research Physician at the Edward Hines Jr. VA Hospital. Additionally, Gerding is an infectious disease specialist and hospital epidemiologist, past president of the Society for Healthcare Epidemiology of America and past chair of the antibiotic resistance committee of SHEA. He is a fellow of the Infectious Diseases Society of America and past chair of the National and Global Public Health Committee and the Antibiotic Resistance Subcommittee of IDSA. His research interests include the epidemiology and prevention of Clostridium difficile, antimicrobial resistance, and antimicrobial distribution and kinetics.

The paper, “Burden of Clostridium difficile Infection in the United States,” was published in the New England Journal of Medicine.

The study, “Changing epidemiology of Clostridium difficile infection following the intriduction of a national ribotyping-based surveillance scheme in England,” was published in the journal Clinical Infectious Diseases.

The study, “Prevalence of antimicrobial use in US acute care hospitals,” was published in JAMA.

The paper, “Vancomycin, metronidazole, or toleyamer for Clostridium difficile infection: results from two multinaionalm randomized, controlled trials,” was published in Clinical Infectious Diseases.

The study, “A Randomized Placebo-controlled Trial of Saccharomyces boulardii in Combination with Standard Antibiotics for Clostridium difficile disease,” was published in JAMA.

“What is C. diff.?” One Woman Walked Up To Us And Asked – Then the Crowd Followed

Heather and Kimberly III 7.23.16

The C Diff Foundation Volunteer Patient Advocates; Heather Clark and
her sister, Kimberly Reilly participated at local events over the summer season  to educate and advocate
for C. diff. infection prevention, treatments, and environmental safety within the local communities raising C. diff. awareness and saving lives.

 

On behalf of the C Diff Foundation , we sincerely thank you Heather and Kimberly for your dedication, your time, and for joining the
C Diff Foundation partnering and sharing our global mission.

We are truly grateful to the many special Volunteer Patient Advocates, the special individuals donating their time in “Raising C. diff. Awareness within their communities” around the globe.  Thank You!

Heather and Kimberly lost their dear Father from C.diff. involvement.  Shortly after his passing,  Heather and Kimberly took a stand with the C Diff Foundation and dedicated their time and efforts in  “Raising C. diff. Awareness” to help educate, and advocate for this life-threatening infection that played a big part in their Father’s passing.

To listen to Heather’s journey, with fellow C. diff. survivors,  – please click on the podcast link below:

http://www.voiceamerica.com/episode/85287/c-diff-survivors-share-their-unique-journey-through-a-c-diff-infection-and-how-it-changed-their

“What is C. diff.?”

Clostridium difficile (C.diff.) is gram-positive, anaerobic, and a spore, rod/spindle-shape,
a common bacterium of the human intestine in 2 – 5%. C diff. becomes a serious gastrointestinal infection when individuals have been exposed to antibiotic therapy, and/or have experienced a long-term hospitalization, and/or have had an extended stay in a long-term care facility. However; the risk of acquiring a C diff. infection (CDI) has increased as it is in the community (Community Acquired CDI) and found in outpatient settings.

There are significant risk factors in patients who are immunosuppressant, ones who have been on antibiotic therapy, and the elderly population.

How do Antibiotics cause C diff.? The antibiotics cause a disruption in the normal intestinal flora which leads to an over growth of C difficile bacteria in the colon. The leading antibiotics known to disrupt the normal intestinal flora, yet not limited to, are Ampicillin, Amoxicillin, Cephalosporins, Clindamycin, and the broad spectrum antibiotics.

Since  November 2012 the CDC has shared public announcements regarding antibiotic use: Colds and many ear and sinus infections are caused by viruses, not bacteria. Taking antibiotics to treat a “virus” can make those drugs less effective when you and your family really need them. Limiting the usage of antibiotics will also help limit new cases of CDI.
*Always discuss the symptoms and medications with the treating Physician.

What are C.diff. Symptoms? Symptoms of Clostridium difficile (C.diff.)
C.diff. strains produce several toxins; the most popular are enterotoxin – Clostridium difficile toxin A and cytotoxin – Clostridium difficile toxin B.  Both strains are responsible for the symptoms of diarrhea, abdominal pain, fever, fatigue, and can advance to a complication of a severe inflammation of the colon; pseudomembranous colitis, which can also lead to further complications of toxic megacolon.

How is C.diff. Transmitted? Mode of transmission of CDI can be either directly or indirectly, hospital acquired (nosocomial) or community – acquired; Ingesting C.diff spores transmitted from others and patients by hands, or altered normal intestinal flora by antibiotic therapy allowing proliferation of C.diff.  in the colon.  Coming in contact with surfaces, devices, or material with Clostridium difficile spores can easily be transferred to individuals by hands that have touched a contaminated surface or item. Examples of surfaces, devices, and materials contaminated with C.diff. spores in hospital and community/outpatient settings: commodes, bath tubs, showers, hand rails, bed rails, counter tops, handles, clothing, medical equipment, and electronic rectal thermometers.

The C Diff Foundation provide a wide range of programs, such as education, and advocacy for C. diff. infection prevention, treatments, support, and environmental safety worldwide, training of volunteer patient advocates (VPA’s) across the globe to provide educational workshops, supplying life-saving medications for those afflicted with this infection from young children to seniors, building satellite branches across the globe, presenting educational workshops in educational programs, improving and expanding the C. difficile infection awareness, providing global tele-conferencing support sessions in mental health counseling, long-term illnesses, the prevention, treatments, environmental safety with nutritional education for patients, and families suffering through a C. difficile infection
and so much more.

We are working together and dedicated at raising C. diff. awareness to witness a decrease in newly diagnosed C. difficile infections worldwide and through dedication and efforts of the
C Diff Foundation Volunteers – we will meet our goals.

Lycoming Fair 7.16.16

 

 

 

 

 

 

Treatments For CDI?   Treating C diff is becoming more challenging to physicians, frustrating to patients, and costly to the health care industry. To date there are three antibiotics effective at treating C diff: Metronidazole is prescribed to treat mild to moderate symptoms and is cost effective (8). Vancomycin is prescribed for moderate to severe symptoms via: oral route as intravenous administration does not achieve gut lumen therapeutic levels. Vancomycin is prescribed to patients with unsuccessful results from the Metronidazole, or the patient is allergic, or pregnant, breastfeeding, or younger than ten years of age.

The most recent antibiotic, Dificid (fidaxomicin) http://www.dificid.com is the first medication approved by FDA to treat C diff. Associated-Diarrhea CDAD in over twenty five years with superiority in sustained clinical response (5) Loperamide, diphenoxylate and bismuth medications are contraindicated as they slow the fecal transit time which extends the toxins in the gastrointestinal system.

The use of Cholestyramine has demonstrated positive results as toxins A and B bind to the resin as it passes through the intestines aiding in slowing bowel motility and assists in decreasing dehydration (9).

C.diff. spores are able to live outside of the body for a very long period of time and are resistant to most routine cleaning agents. It has also been proven that alcohol based hand sanitizers remain ineffective in eradicating C. diff. spores. In 2009 Clorox Commercial Solutions Ultra Clorox Germicidal Bleach ® was named the first and only product to obtain Federal EPA registration for killing C. diff. spores on hard, non porous surfaces when used as directed (1).

Please visit the following Page for additional information:

https://cdifffoundation.org/c-diff-infection-%e2%99%a5-home-care/

 

The CDC also recommends a 1:10 ( 1 cup bleach to 9 cups of water) dilution of bleach and water for cleaning hard non-porous surfaces keeping areas covered with solution for 10 minutes and the solution is to be mixed fresh daily.

Hand hygiene following the guidelines in HAND WASING; it is important to wash hands before entering and exiting a patient’s room (4). The spores are difficult to remove from hands; Universal Contact Precautions remain best practice for healthcare personnel and Contact Precautions for patients with a confirmed diagnosis of CDI. Prevention through education about CDI has proven effective and beneficial to environmental housekeeping departments, health care professionals, administration, patients, and their families (2)

https://cdifffoundation.org/hand-washing-updates/

 

To Join The C Diff Foundation Volunteer Patient Advocate Program, please contact us by email info@cdifffoundation.org  or call us toll-free 1-844-FOR-CDIF

 

 

References:

(1) Clorox registered EPA
http://www.ahe.org/ahe/learn/press-releases/2009/20090402_clorox_epa_cdiff.shtml

(2) Clostridium difficile (CDI) Infections thttp://www.cdc.gov/hai/pdfs/toolkits/CDItoolkitwhite_clearance_edits.pdf
(3) Lab Tests and Diagnosis Mayo Clinichttp://www.mayoclinic.com/health/c-difficile/DS00736/DSECTION=tests-and-diagnosis
(4) CDC Hand washing
http://www.cdc.gov/Features/HandWashing/

(5) FDA announcement Dificid
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm257024.htm

(5) Dificid.com
http://www.dificid.com

(6) Probiotics in the prevention of antibiotic-associated diarrhea
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105609/

(6) Danimals PRNewswire8/Jan2012;
http://www.prnewswire.com/news-releases/dannonr-danimalsr-adds-proven-benefits-of-probiotics-53347947.html

(7) Get smart antibiotics week CDC
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6144a7.htm

(8) Metronidazole
http://www.everydayhealth.com/drugs/flagyl

(9) Cholestyranine
http://www.globalrph.com/cholestyramine.htm

C Diff Foundation Is Approved For Google Ad Grant To Promote Clostridium difficile (C.diff.) Prevention, Treatments, Environmental Safety, And Support Worldwide

 

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The C Diff Foundation announces that it has been approved  for a Google Ad Grant equivalent to about USD 10,000 per month .  Google offers organizations free access to Google tools like Gmail, Google Calendar, Google Drive, Google Ad Grants,

“Nearly half a million Americans suffer from Clostridium difficile (C. diff.) infections in a single year. With annual fatalities close to 29,000 a year, it’s a global problem that affects every community,” explains Nancy Caralla, Executive Director and Foundress of the
C Diff Foundation. “With the support of companies like Google, we can further raise C. diff. awareness, provide information and support  and save lives worldwide.”

We’ are truly appreciative to have Google Ad Grants as part of the C Diff Foundation’s  C. diff. educational and advocacy  program and we are confident that the AdWords Grant will help the C Diff Foundation deliver additional support to patients, their families, and healthcare professionals worldwide.

With the Google Ad Grant the C Diff Foundation is able to help raise C. diff. awareness through education about research being conducted by the government, industry, and academia; and better advocacy on behalf of patients, healthcare professionals, and researchers worldwide working to address the public health threat posed by this devastating infection.

About the C Diff Foundation:
The C Diff Foundation is a leading nonprofit 501(c)(3) organization, established in 2012 and dedicated at supporting public health through education and advocating for C. difficile infection (CDI) prevention, treatments, environmental safety, and support worldwide. The Foundation’s founder is a Nurse and after suffering through C. difficile infections herself and witnessing the loss of her father, whose life was claimed by C. difficile involvement, the
C Diff Foundation came to fruition.

The C Diff Foundation, with their Volunteer Patient Advocates, successfully “Raise C. diff. Awareness” nationwide and in 38 countries, and host a Nationwide information Hot-Line (1-844-FOR-CDIF) which also supports health care providers and patients to manage through the difficulties of a C. diff. infection.

 

Twitter:          @cdiffFoundation   #cdiff2016

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