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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)
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.
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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.
Giving Tuesday Is a global day dedicated to giving back.
On Tuesday, November 29th , 2016 Charities, Families, Businesses, Community centers, and Students around the world will come together for one common purpose: to celebrate generosity and to give.
#GivingTuesday was founded in 2012 by New York’s 92nd Street Y in partnership with the United Nations Foundation. Together, with a team of influential and founding partners together launched a global movement that has engaged over 10,000 organizations worldwide.
Remember the C Diff Foundation in your Giving Tuesday efforts. Your gift is tax deductible and it will support patients touched by the life-threatening C. diffiicle infection, their families, communities and the many programs dedicated in Raising C. diff. Awareness
We appreciate you and all that you do for the good of others.
To Donate please visit the C Diff Foundation Website www.cdifffoundation.org
and choose the tab at the top of the page —
Thank you for your continued support and we are grateful for your generosity.
Shop Amazon to support the many programs and educational workshops provided by the C Diff Foundation worldwide —
It’s a pleasure to share the new way to give to the C Diff Foundation. Amazon will share a portion of the proceeds from your purchases with the C Diff Foundation. While you are shopping on-line you are also donating, and we are grateful.
Here is how it works:
* Shop Amazon through AmazonSmile C Diff Foundation
Click on the link below to access the site
The Global C. difficile Congress FREE Webinar will take place on November 11th at 8:00 a.m. Eastern Time will broaden existing knowledge surrounding C. difficile infection (CDI) prevention, treatments, and environmental safety worldwide. The drive and passion takes us forward in promoting the practical and technical advancements taking place across the globe. Healthcare Professionals from every area of expertise, will discuss the control and treatment options, the healthcare perspectives, antibiotic-resistance stewardship programs, and much more to raise awareness and share successful implementations and guidelines.
The Global C. difficile Congress will be eight sessions presented by topic experts – in four hours – in one day – with goals to change the C. difficile world with a common focus; To
improve C. diff. infection prevention, treatments, and environmental safety in the healthcare communities worldwide.
Twitter chats and tweets take place in honor of the
Global C. diff. Awareness Campaign From November 1st throughout the month.
There will be a #CdiffTwitterChat
Join Us on NOVEMBER 18TH at 3:30 p.m. Eastern Time with International Infectious Disease Expert, Dr. Hudson Garrett Jr. for a real-time Question and Answer Twitter Chat about Clostridium difficile infection and disease. Questions are welcomed from both patients and healthcare providers. Registration is complimentary to all those interested. Click on the link below for more information:
VOLUNTEER PATIENT ADVOCATES:
Follow the C Diff Foundation on
Pinetrest, and LinkedIn and join the fight and save lives.
Thank you for your support that helps our mission continue moving forward.
Educating and advocating for C. difficile infection prevention, treatments, environmental safety and support worldwide.
Be sure to check back as new events will be added weekly.
We are pleased to welcome Ron Romano, RN to the C Diff Foundation Global Network.
Ron Romano, RN presides as Infection Prevention Advocate.
Ron has certifications from the following organizations :
- American Association for LTC Nursing – Co-founder Past President – 2007- 2015
- American Association for Safe Patient Handling – Board Member 2010-2012
- Association for Professionals in Infection Control & Epidemiology – Current Member
- Safety Specialist LTC – Certification – Current
C. difficile Infections are no stranger to Ron as his family members have also been touched by this infection. His background in healthcare and passion for Infection Prevention and Epidemiology is an asset to many. Ron is the Owner, President and CEO of Safety Net LLC in Cincinnati, Ohio.
Safety Net is a national healthcare safety consulting and distribution company providing unique product solutions to mitigate risk associated to infections. We serve acute care hospitals, post-acute and home-care. Our solutions protect our healthcare workers and those under their care.
Ron has also been the Past-President in the following organizations:
American Association for LTC Nursing (AALTCN) 07-15 The AALTCN is a professional organization that supports all levels of caregivers providing career ladder with supporting education, certifications and resources. AALTCN has recently merged with the American Association for Nurse Assessment Coordinators to form the largest professional nursing organization in long term care.
Health Education Network – 07-15, Co-owner – President
Health Education Network is a medical publication company that provides Nursing education for all levels of caregivers on a variety of topics for LTC. Certificate programs are available for Staff Development Coordinators, Nurse Assessment Coordinators, Director of Nursing in LTC, RN and LPN in LTC.
National Association Director of Nursing Administration (NADONA/LTC) Cincinnati, Ohio 01-07
NADONA/LTC is a professional organization representing Directors of Nursing, Assistant Directors of Nursing and Clinical Managers in long-term care. NADONA/LTC has 38 state chapters nationally and internationally in Canada.
We welcome Ron to the C Diff Foundation and appreciate his healthcare background to join us in promoting Infection prevention and C. diff. Awareness worldwide with fellow members