Tag Archives: Dr. Paul Feuerstadt MD

A Real-World Data Analysis – Study Shows the Clinical Complications In Patients With Primary CDI and Recurrent C. difficile Infections

Reduction in recurrent C. difficile infection is an important step to reduce the burden of serious clinical complications, and new treatments are needed to reduce C. difficile infection recurrence.

Keywords Clostridium difficile infection, Clostridioides difficile infection, recurrent Clostridioides difficile infection, sepsis, real-world analysis

Clostridioides difficile infection (CDI) has a national burden of 462,100 cases in 2017 according to the latest estimate from the US Centers for Disease Control and Prevention (CDC).1 The CDC also reported that the burden of recurrent CDI (rCDI) remained unchanged over the 7 years of observation, despite a decreasing trend in healthcare-associated CDI. The clinical burden of CDI has many facets, from a prolonged hospital stay, increased risk of sepsis, and need for surgical intervention.2 Previous research has shown that septic shock complicated CDI in 34.7% of patients being mechanically ventilated.3 When managing severely ill patients with CDI, the need for colectomy may arise.4 While bowel surgery can save the lives of patients with severe CDI, the procedure carries a significant risk of mortality.5 Taken together, the unmet needs of patients with CDI and rCDI remain high, but more precise information about the clinical burden is critically needed.

Approximately 25% of patients with an initial CDI episode experience rCDI, and 40%–65% of patients with one recurrence will experience multiply-recurrent CDI (mrCDI; two or more recurrences).6,7 While there is significant knowledge about the epidemiology and clinical manifestations of CDI, fewer clinical data exist from real-world analyses of CDI and rCDI complications of sepsis and bowel surgery, and the available data are not adequately generalizable to a broad US population.7–10 Furthermore, there is limited knowledge of the clinical burden of the rapidly growing patient subgroup with mrCDI.11,12

The objective of this study was to quantify clinical complications of sepsis and bowel surgery in real-world patients who suffered CDI and rCDI. The study analyzed a large commercial healthcare claims database containing payment information for patients who received care in a variety of healthcare settings such as inpatient hospitals, outpatient hospitals, clinics, and pharmacies in the United States. Real-world analysis of cost and healthcare resource utilization in patients with CDI and rCDI was reported in a separate report.13

Study design

This longitudinal, retrospective study utilized real-world data from the PharMetrics PlusTM database (IQVIA; Durham, NC), which contains de-identified data from claims, enrollment, and demographic information for more than 140 million individuals with commercial insurance coverage throughout the United States, with data originating from over 90% of hospitals and over 90% of all US physicians.

Study population

Individuals included in the study were aged between 18 and 64 years and had at least one inpatient visit with a diagnosis of CDI (Supplementary Table 1) or one outpatient visit with a CDI diagnosis code followed by an outpatient CDI treatment. The requirement of an observable CDI treatment for an outpatient CDI visit ensured that follow-up visits would not be counted as a recurrence. Treatment was defined as an outpatient prescription for vancomycin, fidaxomicin, metronidazole, rifaximin, or bezlotoxumab, or fecal microbiota transplant (FMT).

Index CDI episodes occurred between 1 January 2010 and 30 June 2017, the latest data cutoff available at the time of the study (Figure 1). Only patients who were continuously enrolled and observable 6 months before and 12 months after the first date of the index CDI episode were included. The pre-index period was used to quantify pre-CDI healthcare exposure and to minimize the likelihood that the first CDI diagnosis was a recurrent episode, while the post-index requirement allowed sufficient time for observing recurrences as well as ensured accurate quantification of post-index complications.

Figure 1. Study design: (a) the index CDI episode was followed by a 14-day claim-free period after last CDI claim and an 8-week period to identify rCDI and (b) the red star indicates a hypothetical point at which the first rCDI episode occurs during the 8-week window after the claim-free period. Following this first rCDI episode, a new 14-day claim-free period occurs plus a new window for a subsequent rCDI episode. Multiple rCDI could occur after an index CDI event in this manner, up until 12 months following the index CDI date.

For this type of analysis, the beginning and end of CDI episodes must be clearly defined to capture the primary CDI event and the recurrences. A CDI episode started from the date of the index (first) CDI claim observed in the study time frame. Each CDI episode included consecutive medical claims with a CDI diagnosis and prescription medication fills that are common treatment for CDI. Medical claims included any inpatient and outpatient services with a CDI code. Each CDI episode would end after a 14-day CDI-claim-free period was observed (Figure 1). An episode of rCDI was defined as a second or subsequent CDI episode, using the same criteria as above for the index CDI episode, within an 8-week window following the end of the previous CDI episode. This 8 week window has been used by the CDC to define recurrences.14 CDI events that occurred later than each 8-week window were not counted as recurrences and therefore were excluded in this analysis. mrCDI could occur after an index CDI event, up until 12 months following the index CDI date. The study population was stratified into mutually exclusive groups of patients with 0 rCDI (had primary CDI only), 1 rCDI, 2 rCDI, or 3+ rCDI.

Outcomes

Clinical complications were quantified for the 12-month period after an index CDI, for all study patients and by cohorts for number of rCDI episodes (0 rCDI, 1 rCDI, 2 rCDI, or 3+ rCDI). Sepsis, subtotal colectomy, and diverting loop ileostomy were identified by a medical claim with relevant codes (Supplementary Table 1). If there were multiple medical claims with sepsis diagnosis code, claims occurring with service dates within a 7-day period were grouped together as a single acute sepsis episode.

Data analysis

Patient characteristics and clinical complications for the cohorts were displayed using counts and percentages for categorical variables and measures of central tendency (mean (standard deviation—SD)) for continuous variables. Statistical analyses were conducted with SAS, version 9.3 (SAS Institute, Inc., Cary, NC, USA).

Demographic and baseline characteristics

A total of 46,571 patients with an index CDI episode were included: 3129 (6.7%) experienced one recurrence, 472 (1.0%) had two recurrences, and 134 (0.3%) developed three or more recurrences (Table 1). The mean (SD) age was 47.4 (12.7) years, and 62.4% were female (Table 1). The mean (SD) baseline Charlson comorbidity index (CCI) score, by increasing the rCDI group, was 1.2 (1.9), 1.5 (2.2), 1.8 (2.3), and 2.3 (2.5). Autoimmune diseases (such as ulcerative colitis, Crohn’s disease, type 1 diabetes, rheumatoid arthritis, or multiple sclerosis) were present in 18.1%, 23.1%, 24.6%, and 39.6% of patients, by increasing the rCDI cohort.

Table 1. Demographic and baseline characteristics.

Table 1. Demographic and baseline characteristics.

Pre-index healthcare exposures

During the 6-month baseline period, antibiotics were prescribed for ⩾76% of patients in all groups (Table 1). Gastric acid–suppressing agents were prescribed, by increasing the rCDI cohort, for 27.9%, 32.9%, 39.0%, and 38.1% of patients. Gastrointestinal surgery or administration of chemotherapy was more frequently noted with higher rCDI cohorts during the baseline period. Baseline healthcare exposure was generally highest for those in the 3+ rCDI group, with 86.6% having an outpatient hospital visit, 60.5% having ⩾1 inpatient admission, and 57.5% having an ED visit within 6 months immediately preceding the index CDI episode (Table 1).

Treatment patterns

At the time of the study, standard of care for CDI treatment primarily involved the use of antibiotics, while FMT was used rarely. Across all index and rCDI episodes (n = 46,571), vancomycin was used to treat 16,215 (34.8%), metronidazole was used to treat 25,298 (54.3%), and fidaxomicin was used to treat 1738 (3.7%) of patients. For recurrences, vancomycin was the most commonly prescribed antibiotic used, with 55% receiving this with their first recurrence, 56% with their second recurrence, and 60% with the third recurrence (Figure 2). As expected, metronidazole treatment rates were lower for recurrences versus primary CDI, particularly in patients with second or third recurrences (19% and 17%, respectively). Fidaxomicin was used to treat a minority of patients at each recurrence episode.

Figure 2. Vancomycin was the most commonly prescribed antibiotic to treat the first, second, and third rCDI episodes, followed by metronidazole and then fidaxomicin.

Few study patients (333/46,571; 0.72%) had FMT procedures in the year after index episode. The proportion of patients who received FMT procedures was slightly higher during the later study years between 2014 and 2017 (0.89%) compared with 2010 and 2013 (0.54%). Among the 333 patients who had FMT, 364 procedures were conducted, with 27 patients having ⩾2 FMT procedures. More than half (55.6%) of the FMT procedures were performed in patients who had no recurrences (i.e. to treat the index CDI episode), corresponding to FMT being performed in 0.43% (185/42,836) of the cohort with no recurrence. The utilization of FMT increased with the number of recurrences experienced: 3.1% (97/3129) of patients with one recurrence, 8.1% (38/472) with two recurrences, and 9.7% (13/134) with three or more recurrences received FMT.

Post-index clinical complications

During the 12-month follow-up, sepsis occurred in 16.5%, 27.3%, 33.1%, and 43.3% of patients by increasing the rCDI group. The proportion of patients who had two sepsis episodes during follow-up was highest for the 3+ rCDI cohort (Figure 3(a)). No patient had more than two sepsis episodes during the 12-month follow-up period. Likewise, subtotal colectomy or diverting loop ileostomy was performed in 4.6%, 7.3%, 8.9%, and 10.5% of patients, respectively, during the follow-up (Figure 3(b)).

Figure 3. Rates of (a) sepsis and (b) subtotal colectomy or diverting loop ileostomy during the 12 months after index CDI, by recurrence cohort.

CDI and rCDI are associated with substantial patient and healthcare burden. Within our study, patients with mrCDI had high rates of all-cause sepsis and the need for surgical intervention via subtotal colectomy or diverting loop ileostomy. Mirroring the high clinical burden of mrCDI seen in this analysis, patients with three or more recurrences also had the highest healthcare resource utilization and total, all-cause, direct medical costs of all recurrence cohorts.13

During the 12-month follow-up, rates of sepsis were notable and highest for patients with three or more recurrences. Over 40% of patients with three or more recurrences went on to develop sepsis during the study period, and over 30% had two sepsis episodes. As there are few distinguishing factors for patients who suffer one versus multiple recurrences, the higher rate of sepsis in patients with more recurrences is likely due to this high-risk cohort having more opportunities to suffer such adverse outcomes.13 In a retrospective study performed at two large institutions, Falcone et al.15 demonstrated that 18.3% of patients with CDI developed a bloodstream infection (BSI) within 30 days following the CDI episode, most of whom were being treated for a CDI recurrence. Furthermore, the 30-day mortality rates for those with or without BSI were 38.9% versus 13.1% (p < 0.001), respectively.15 Ianiro et al.,16 reporting the results of a single-center study of patients with rCDI, found a 22% rate of BSI after rCDI treatment with antibiotics, and a 90-day mortality rate of 52.5% for those who developed a BSI. Sepsis carries a significant economic burden, with a mean cost of over US $16,000 per hospitalization in the United States; sepsis cases not diagnosed until after admission and those with higher severity had a higher economic burden than average.17 Among patients readmitted with rCDI in the State Inpatient Databases, there is a significant gap in reimbursement of almost US $8000 to US $18,000 for patients who present with rCDI and septicemia on admission.18 There are several theories regarding the pathophysiological basis for BSI in patients with CDI and rCDI. Most focus on disruption of the gut microbiota and/or a cellular inflammatory response, resulting from an impaired gut barrier function and immune response to CDI toxins.19,20 Regardless of mechanism, our study, which had longer follow-up than other studies, revealed that in a broad population of patients with CDI, 16.5% of patients developed BSI and greater than 25% of those with one or more recurrence suffered this complication. We believe this indicates that the consequence of sepsis/BSI in patients with CDI might be more significant than previously thought when considered across a larger population.

The burden of colectomy was also apparent in the study population, with ~5% of those with no recurrences undergoing the surgery and >10% of those with three or more recurrences. Other studies estimated colectomy rates of 1.2%–8.7% in patients with CDI (initial and rCDI).12,2123 In the National Hospital Discharge Survey, 1.3% of patients with CDI required a colectomy.24 Our colectomy data trended higher than previous reports, which may be related to the large cohort size, real-world nature of the data analyzed, the younger age of the population studied, a longer follow-up period, and/or a broader group of healthcare settings. Colectomies create a significant burden for the patient and the healthcare system. Colectomy to treat CDI is associated with a lengthy hospital stay, with a mean (SD) stay of 33 (28) days for those who survived to discharge.25 Colectomy is also a significant predictor of mortality following CDI (odds ratio: 3.14).24 The in-hospital mortality rate following colectomy for CDI varies widely but is substantial, ranging from 36% to 80%.25 Over 75% of those who have a colectomy for CDI suffer colectomy-related morbidity within 30 days, with 65% of patients suffering serious complications.26 These post-operative complications underscore the patient’s burden of CDI, especially those with mrCDI. The cost of a colectomy to treat rCDI is estimated at US $39,000 (2016 dollars]).23 In patients readmitted for rCDI after a major operating room procedure, there is average reimbursement gap of US $20,000.18

Despite being a new therapeutic paradigm for rCDI, FMT use was observable during the study period. The use of FMT for rCDI has gained momentum in recent years, with the enforcement discretion by the FDA and the advent of stool banks.27 FMT remained a rare observation in this claims data set, which may be attributable to FMT being considered a novel and relatively unknown management option during the study period, a lack of coverage for the procedure by health plans, cash payment for the procedure (which would not be captured by the database), or underreporting/miscoding of FMT procedures. A small number of patients (0.7% of the entire cohort) received FMT, with a slight increase in FMT rates with more recurrent episodes. Interestingly, the timing of FMT procedures was largely not in accordance with current or prior guidelines, with most of our observed FMT procedures performed after the index CDI.4,28 An analysis from the Indiana University Hospital reported data from patients with severe and fulminant CDI who received FMT.29 The median number of prior CDI was 0, meaning that at least half of the 225 patients received FMT after their primary infection. Our data may reflect similar use pattern; however, this practice would be considered experimental and did not align well with available guideline recommendations at the time or currently.28,30 Additional research on the practice patterns of FMT is needed to evaluate appropriateness of use.

The recurrence rates seen in our study are somewhat lower than those reported in the literature.6,31 These lower rates are likely due to our study including a younger cohort (aged 18–64 years) than other studies, which are predominantly a population aged 65 years or older, the data source being solely an employer-covered population (which tends to be healthier on average than the entire adult population), in addition to the stringent criteria we used to identify rCDI cases, as detailed by literture13,3133 To address the key objective of quantifying the occurrence of clinical complications, our study included patients who had a minimum of 18 months of continuous enrollment (6-month look back plus 12-month follow-up). This criterion excluded patients who disenrolled before 12-month follow-up, including patients who died or those who lost or changed health insurance for any reason, the reason for which the database does not disclose to protect patient’s privacy. Importantly, exclusion of patients who died during the study period after index CDI ensured that the study cohorts were sufficiently homogeneous, as the level and type of medical care provided to dying patients would have been distinctly different, potentially skewing the data and rendering it less valuable. The impact of these inclusion criteria is that, given the potential mortality consequence of CDI complications reported in the literature, this analysis may have underestimated the proportion of patients who developed sepsis or required colectomy. Claims data can be limited by the misclassification of medical conditions or by missing events/diagnoses. In this study, CDI was identified by diagnosis codes and CDI-related treatments and not by diagnostic test results, which may have resulted in random misclassifications. In addition, claims-related bias may have resulted in an underreporting of sepsis event counts (i.e. sepsis occurred during a hospitalization but was not coded). As this was a descriptive study and was not designed for hypothesis testing, we did not perform a sample size calculation a priori; the sample from the commercial claims database resulting from the inclusion criteria was used for the analyses. Despite the potential limitations and underestimations, we believe that our study provides a good cross-sectional view of a broad population in the United States who experienced CDI and rCDI and resulted in a large population (~46,000) of individuals with CDI to describe. In addition, the incidence of CDI-related surgeries and sepsis was further detailed in cohorts stratified by rCDI group. The results may be generalized to adult populations younger than 65 years who remained with a healthcare system for at least 1 year after the primary CDI episode. Specifically, healthcare decision makers may use our findings to estimate the lower bound of the clinical burden of rCDI.

Our findings indicate that, among patients with more rCDI, there was a parallel trend for higher rates of colectomy and sepsis. These complications have been documented in previous studies to be associated with poor outcomes. Reduction in rCDI may be an important step to reduce the burden of serious clinical complications.

Medical writing and editorial support was provided by Agnella Izzo Matic, Ph.D., CMPP (AIM Biomedical, LLC) and was funded by Ferring Pharmaceuticals, Inc. Portions of the data contained in this article appeared in abstract/poster form at ACG Annual Scientific Meeting, 25–30 October 2019.

Author contributions
L.S., D.N.D., N.S., K.L., and W.W.N. designed and conducted the study. All authors analyzed and interpreted the data, drafted and critically revised the article for important intellectual content, and approved the article for publication.

Declaration of conflicting interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M.B., L.S., W.W.N., and D.N.D. are employees of Ferring Pharmaceuticals, Inc. P.F. has served as a consultant to and on the speaker’s bureau for Merck and Co and has served as a consultant for Ferring Pharmaceuticals, Inc. and Roche Pharmaceuticals. N.C.S. and K.L. are employees of Precision Health Economics and Outcomes Research and provided consulting services to Ferring Pharmaceuticals, Inc.

Ethical approval
This study was exempt from institutional review board approval, as it did not involve any interventional biomedical research with human subjects. Ethical approval was not sought for this study because the data used were de-identified medical and pharmacy claims data, and they were obtained by HIPAA-compliant methods.

Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by Ferring Pharmaceuticals, Inc. (Parsippany, NJ).

Source:  https://journals.sagepub.com/doi/full/10.1177/2050312120986733

C. diff. Infection and Sepsis Overview During a One Year Follow Up

Sepsis was a common Clostridioides difficile infection (C diff) complication throughout a 12-month follow-up period and was most commonly observed in the cohort of patients with 3 or more C diff infection recurrences, according to a paper published in SAGE Open Medicine.

Investigators from around New England conducted a retrospective analysis of more than 46,000 adult patients with C diff infection in order to evaluate the clinical complications of C diff in patients with index and recurrent cases. The investigators used the IQVIA PharMetrics Plus database to looks for patients aged 18-64 years with an index C diff episode that required inpatient stay or an outpatient visit, followed by a treatment for the infection. Treatments included vancomycin, fidaxomicin, metronidazole, rifaximin, or bezlotoxumab, or fecal microbiota transplant (FMT – though it was rare).

Each infection ended after a 14-day C diff-free period was observed, leaving recurrent C diff to be defined as further infection within an 8-week window for a period of 12 months.

To read the article in its entirety please click on the following link to be redirected:

https://www.hcplive.com/view/sepsis-among-common-c-diff-complications-during-one-year-follow-up-period

A total of 3129 patients (6.7%) experienced 1 recurrence, while 1% had 2 recurrences, and 0.3% had 3 or more recurrences. The study authors also noted that autoimmune diseases, such as ulcerative colitis, Crohn’s disease, type 1 diabetes, rheumatoid arthritis, and multiple sclerosis, were present in 18%, 23%, 24%, and nearly 40% of patients, respectively, in patients with 0, 1, 2, or 3 or more C diff infection recurrences.

Antibiotics were prescribed for three-quarters of all patients in all groups in the 6 months preceding the index C diff infection, the investigators found. Gastric acid-suppressing agents were prescribed in 28%, 33%, 39%, and 38%, respectively, in patients with 0, 1, 2, or 3 or more C diff infection recurrences, the study authors also noted.

Vancomycin was used to treat about a third of all index C diff infection patients, while metronidazole was used to treat a little more than half of the patients, the study authors wrote. Fidaxomicin was used to treat about 4% of patients. Vancomycin was the most commonly prescribed antibiotic used in recurrent C diff cases, with 55% of patients getting the antibiotic for the first recurrence, 56% getting it for their second recurrence, and 60% getting it for their third recurrence.

During the 12-month follow-up period, the investigators observed sepsis in 16%, 27%, 33%, and 43%, respectively, in patients with 0, 1, 2, or 3 or more C diff infection recurrences. No patient had more than 2 sepsis episodes during the 12-month follow-up period. Additionally, subtotal colectomy or diverting loop ileostomy was performed in 4%, 7%, 9%, and 10% of patients, respectively, in patients with 0, 1, 2, or 3 or more C diff infection recurrences.

“Our findings indicate that, among patients with more recurrent C diff infection, there was a parallel trend for higher rates of colectomy and sepsis,” the study authors wrote.

The study authors also said that patients with 3 or more recurrences also had the highest health care resource utilization and total, all-cause, direct medical costs of all the recurrence cohorts. Sepsis was highest among this group with the most recurrences, and the study authors hypothesized that this was due to having more opportunities to suffer from this type of adverse outcome.

“Reduction in recurrent C diff infection may be an important step to reduce the burden of serious clinical complications,” they concluded.

Sepsis Resources: 

https://www.global-sepsis-alliance.org/

https://www.sepsis.org/

 

Monday, April 27th – 6:00 p.m. EST Leading Gastroenterologist’s Caterina Oneto, MD & Paul Feuerstadt, MD Host C. diff. Global TeleSupport Network

MONDAY,  April 27th   –  6:00 p.m. EST
Hosts and Co-Directors

Doctors Caterina Oneto, MD &
Paul Feuerstadt, MD

 

Topic:  Doctors Oneto and Feuerstadt will discuss C. difficile Infections; The What, Where and How.  There will be opportunities to ask a  brief question to the physicians.  We appreciate Dr.’s Oneto and Dr. Feuerstadt for donating their time to discuss C. difficile Infections and to provide information regarding prevention, treatments available, and environmental safety products available.   Join Dr. Oneto and Dr. Feuerstadt’s session hosted on the fourth Monday of each month.
Via: Teleconference Call:  1 – 646 -927 – 0297   Conference ID:  123560#
3:00 p.m. PT     4:00 p.m. MT     5:00 p.m. CT    6:00 p.m ET

NOTE:  The Physicians will not prescribe, diagnose, or provide medical assessment answers to any individuals participating in their support session.  Please contact the Physician providing care for a C. diff. Infection or other diagnoses that are being treated.    Thank you.

 

SUPPORT IS JUST A PHONE CALL AWAY

Support and information sessions are for everyone especially for —

  • Families.
  • Clinicians,
  • C. diff. survivors continuing their recovery from a prolonged illness.
  • Patients working their way through any long-term wellness draining diagnosis.

All Sessions are FREE and accessible from the USA and 57 countries  *

Support is available to anyone seeking additional information with the desire to speak with others that understand the journey.

  • PLEASE NOTE *  If you, or anyone you know, are experiencing mental or physical symptoms causing pain, fever, discomfort, C. difficile symptoms or changes in a diagnosed infection, or a change in emotional behavior or having suicidal thoughts, DO NOT wait for a scheduled support session.  Contact a physician or seek medical attention at a local clinic or hospital immediately. Thank you.

The C. diff. Global TeleSupport Network program is the first-ever FREE GLOBAL patient and family educational support program developed by a U.S. non-profit 501(c)(3) — The C Diff Foundation is dedicated to educating and advocating for C. difficile infection prevention, treatments, clinical trials, support, and environmental safety worldwide.

C Diff Foundation with Leading Gastroenterologist’s Oneto and Feuerstadt Announce November Clinic Dedicated for C.difficile

C Diff Foundation ( https://cdifffoundation.org/)  is a one hundred percent volunteer, world-renowned 501(c)(3) not-for-profit organization and has announced that the Foundation will offer a November clinic sponsored by the C Diff Foundation and dedicated to patients diagnosed and recovering from a C. difficile infection (CDI).

The November 19th C Diff Foundation Clinic will be hosted by Concorde Gastroenterology at their  233 Broadway Suite 840,  New York, NY 10279 office.
The clinic will hold office hours from 10:00 a.m. until  4:00 p.m. ET
With Doctor’s Caterina Oneto, MD and  Paul Feuerstadt, MD

Please call +1 212 889 5544 Ext 199
To schedule an appointment.

The August clinic received an overwhelming response from patients in various stages of recovery, including 15 individuals already scheduled with multiple spots planned for patients with recently diagnosed infection or those who have had multiple episodes and need further guidance and management.

Dr. Oneto said, “Through this clinic, we will provide access to high-level care to a number of new consults, as well as existing patients, who are recovering from the infection. It is my pleasure to partner with the C Diff Foundation and lend my expertise to the management and hopefully, eradication of this debilitating disease.”

“We are delighted with the immediate and overwhelming response from the patient community. It is a testament to the needs of those suffering from this infection. With this clinic, we hope to bring awareness, education and more importantly, cutting edge treatment to the general public,” stated Dr. Feuerstadt.

There are plans for additional clinic dates in 2020  in Florida, New York, Connecticut, Illinois, and Minnesota.

“The clinics demonstrate Doctor Oneto and Feuerstadt’s commitment over the years raising
C. diff. awareness while providing management of those suffering with
a C. diff. infection. Patients who might not otherwise be able to gain access to providers sub-specializing and caring for those with this infection will have this opportunity available.  Doctor’s Oneto and Feuerstadt’s dedication resonates within the C. diff. community and we are grateful for their participation and support.” stated Nancy Caralla, Founding President and Executive Director of the C Diff Foundation.

About C Diff Foundation

C Diff Foundation’s mission is dedicated to reaching out to communities from villages to cities, to medical practitioners, medical students, C. diff. survivors, caregivers, and the patients combating a C. difficile infection (CDI) while providing the general public important information on prevention, treatments available, clinical trials in progress, nutrition, diagnostics, and EPA registered products available for environmental safety worldwide.

About Caterina Oneto, MD

Dr. Caterina Oneto, MD is a Gastroenterologist in private practice in New York and is affiliated with NYU Langone. She completed her Fellowship in Gastroenterology at Montefiore Medical Center, Albert Einstein College of Medicine. Dr. Oneto is the Co-Director of Clinical trials at Concorde Medical Group. Her main focus is Irritable Bowel Disease (IBD),

About Paul Feuerstadt, MD

His areas of interest Clostridioides difficile infection (CDI) and ischemic diseases of the gut and in these areas he has presented his research extensively, authored and co-authored many manuscripts, textbook chapters, and online modules. Another passion of Dr. Feuerstadt is teaching, frequently giving lectures locally, regionally and nationally. He holds a clinical appointment as an Assistant Clinical Professor of Medicine at the Yale University School of Medicine and is a full-time attending physician at the Gastroenterology Center of Connecticut seeing patients with a broad spectrum of clinical gastroenterological diseases.

Dr. Feuerstadt attended the Weill Medical College of Cornell University in Manhattan for medical school and completed his residency in internal medicine at New York-Presbyterian Hospital/Weill Cornell. His clinical fellowship training was completed at Montefiore Medical Center in the Bronx, New York.

Clostridioides difficile infections (AKA C. diff., C.difficile, CDI) and Microbiome modification.
Dr Oneto is also Co-Director of the C.diff. Community Global Support program offered by the
C Diff Foundation.  Dr. Oneto appears regularly on Doctor Radio on Sirius Xm
and C. diff. Spores and More Radio (cdiffradio.com).

About C.difficile

It is the most common Healthcare-associated infection affecting an estimated 450,000 people annually in the United States alone with ~28,000 deaths from complications of this infection. This infection accounts for ~16% of all healthcare-associated infections.

In the USA: Nearly half a million Americans suffer from Clostridioides difficile (C. diff.) infections in a single year according to a study released on February 25, 2015, by the Centers for Disease Control and Prevention (CDC).

**Approximately 29,000 patients died within 30 days of the initial diagnosis of C. difficile. Of those, about 15,000 deaths were estimated to be directly attributable to C. difficile infections (CDI), making C. difficile a very important cause of infectious disease death in the United States alone. More than 80 percent of the deaths associated with C. difficile occurred among Americans aged 65 years or older. C. difficile causes an inflammation of the colon and deadly diarrhea.

C Diff Foundation Announces Appointment of Paul Feuerstadt, M.D., Director of Medical Education

C Diff Foundation, a one hundred percent volunteer, world renowned 501(c)(3) not-for-profit organization, has appointed nationally renowned Gastroenterologist, Dr. Paul Feuerstadt as its first Director of Medical Education.

Dr. Feuerstadt said, “It is my honor to accept this position. I have been involved with the C Diff Foundation over the last 4.5 years and I look forward to assisting in the continued growth of the organization and ensuring that forward progress, awareness and education increases under my tenure. I look forward to working with the board and volunteers to increase awareness and funding across the country and around the world to highlight this disease through in person events, social media, and in the press.”

Dr. Feuerstadt has spent his career refining his practice and expertise in C. difficile. He is dedicated to educating the public through his work with this organization.

Additionally, he plans to offer free patient and provider education through the launch of his new educational website, EverythingCdifficile.com. The goal of the site is to provide education through short videos with relevant clinical information for educational purposes. The site provides concise 3-5 minute lectures covering core topics, recent publications and major conferences about C. difficile infection to educate both patients and providers.

Nancy C. Caralla, Founding President, C Diff Foundation, commented: “Dr. Feuerstadt is a pre-eminent doctor in this space. His dedication and donation of his time and energy to this worthy cause has helped so many patients to date. We look forward to his enhanced leadership and knowledge as the organization grows and strengthens through our advocacy in
the C.diff. community. Dr. Feuerstadt’s new role as Director of Medical Education will provide an additional avenue of support to patients, families, caregivers, and healthcare providers  through his educational media available on EverythingCdifficile.com. We are grateful for Dr. Feuerstadt’s time and dedication as we continue fighting this debilitating disease worldwide.”

About Dr. Paul Feuerstadt:

His areas of interest Clostridioides difficile infection and ischemic diseases of the gut and in these areas he has presented his research extensively, authored and co-authored many manuscripts, textbook chapters and online modules. Another passion of Dr. Feuerstadt’s is teaching, frequently giving lectures locally, regionally and nationally. He holds a clinical appointment as an Assistant Clinical Professor of Medicine at the Yale University School of Medicine and is a full time attending physician at the Gastroenterology Center of Connecticut seeing patients with a broad spectrum of clinical gastroenterological diseases.

Dr. Feuerstadt attended the Weill Medical College of Cornell University in Manhattan for medical school and completed his residency in internal medicine at New York Presbyterian Hospital/Weill Cornell. His clinical fellowship training was completed at Montefiore Medical Center in the Bronx, New York.