Disclosures Clostridium difficile infection and Antibiotic - - PDF document

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Disclosures Clostridium difficile infection and Antibiotic - - PDF document

Jun 09, 2023 271 likes •435 views

Disclosures Clostridium difficile infection and Antibiotic stewardship

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SLIDE 1

Clostridium difficile infection and Antibiotic stewardship

  • Disclosures

Outline

  • Some controversy

Clostridium Clostridioides difficile

  • Clostridium difficile

Clostridioides difficile

  • C. difficile
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SLIDE 2

One of CDC’s 3 “Urgent Threats”

CDI background

  • Epidemiology trends, inpatients
  • Prevention: Antibiotic Stewardship
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SLIDE 3

Antibiotic use affects the population risk

  • Risk for CDI if prior room occupant got antibiotics = HR 1.22 (1.02-1.45)

Diagnostic testing

  • C. diff
  • C. difficile infection versus colonization
  • Overdiagnosis of C. diff infection with molecular testing
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SLIDE 4

Neither usEIA nor PCR ct distinguish infection vs colonization

  • Approach to C difficile testing
  • UCSF CDI testing algorithm

MANAGEMENT

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SLIDE 5

Treatment scenario #1. 63 y/o F recently treated for a UTI with levofloxacin, now having watery stools 4x/day, fever to 38.3, WBC 11K, Cr 1.0. Other vitals stable. PCR positive for C. difficile toxin. With what should you treat her? CDI Rx no longer depends on severity!

Zar F A et al. Clin Infect Dis. 2007;45:302-307; McDonald LC et al. CID, cix1085, https://doi.org/10.1093/cid/cix1085

  • Initial uncomplicated CDI, severe or non-severe
  • RCTs metronidazole vs. vancomycin
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SLIDE 6

New evidence to support vancomycin

  • What about fidaxomicin?
  • Additional considerations
  • Take-home
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SLIDE 7
  • Enterococcal
  • C. difficile
  • First recurrence, non-fulminant CDI
  • Evidence to support VAN taper
  • Kelly and LaMont, N Engl J Med. 2008;359(18):1932-40.

Vancomycin taper

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SLIDE 8

Risk for recurrent CDI

  • Incidence of mrCDI has increased 188%
  • Second/subsequent recurrence
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SLIDE 9

A word on rifaximin chaser

  • FMT
  • Fidaxomicin fared worse than FMT for rCDI
  • FMT adverse events
  • Drekonja D et al. Ann Intern Med 2015;162(9):630-8.
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SLIDE 10

FMT durability

  • Take-home
  • Fulminant CDI
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SLIDE 11

Total colectomy with end ileostomy

  • Diverting loop ileostomy + colonic lavage
  • Multicenter loop ileostomy study
  • Take-home for severe, complicated CDI
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SLIDE 12
  • Probiotics for CDI
  • Approaches to prevent CDI
  • Spread of CDI in the hospital
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SLIDE 13

Identification and isolation of carriers reduces CDI incidence

  • Impact of interventions on C diff isolation days
  • Prevention: Antibiotic Stewardship
  • Impact of Antimicrobial Stewardship Programs (ASP)
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SLIDE 14

Non-toxigenic C. diff for secondary prevention

  • Monoclonal antibodies targeting toxins A/B

Monoclonal Abs for secondary prevention: MODIFY I and II trials

  • Monoclonal Abs for secondary prevention: MODIFY I and II trials
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SLIDE 15

C diff vaccine? CDI prevention summary

  • C. diff
  • CDI take-home
  • THANK YOU!