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AMDA Long Term Care Medicine - 2014


204 - C.difficile Infection: Prevention and Newer Treatments


Feb 28, 2014 11:00am ‐ Feb 28, 2014 12:00pm

Standard: $24.00

Description

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this Internet Enduring Material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of clinical 1.0 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
This session will briefly present the increasing dilemma of C.difficile infection in long-term care. It will focus on prevention of infection with a discussion on the critical role of normal gut flora, antibiotic stewardship, and hand/environmental hygiene. The presenters will review literature on newer treatments of C.difficile infection, including the practical and regulatory impact of fecal transplant.

Learning Objective(s):

  • Recognize the impact of C.difficile infection on residents in long term care.
  • Examine the current literature on the effect of intestinal flora on C.difficile infection and impact of antibiotic use.
  • Describe the literature for newer treatments for C.difficile infection, including regulations and procedures.

Speaker(s):
Laurie Archbald-Pannone, MD, MPH; Glynis Kolling, PhD

Disclosure(s):
None

Reference(s):
Archbald-Pannone L, Sevilleja JE, Guerrant R. Diarrhea, clostridium difficile, and intestinal inflammation in residents of a long-term care facility. J Am Med Dir Assoc. 2010 May;11(4):263-7. doi: 10.1016/j.jamda.2009.09.006. Epub 2010 Mar 15. PMID: 20439046Pawlowski SW, Archbald-Pannone L, Carman RJ, Alcantara-Warren C, Lyerly D, Genheimer CW, Gerding DN, Guerrant RL. Elevated levels of intestinal inflammation in Clostridium difficile infection associated with fluoroquinolone-resistant C. difficile. J Hosp Infect. 2009 Oct;73(2):185-7. doi: 10.1016/j.jhin.2009.05.013. Epub 2009 Aug 26. PMID: 19709778Samie A, Obi CL, Franasiak J, Archbald-Pannone L, Bessong PO, Alcantara-Warren C, Guerrant RL. PCR detection of Clostridium difficile triose phosphate isomerase (tpi), toxin A (tcdA), toxin B (tcdB), binary toxin (cdtA, cdtB), and tcdC genes in Vhembe District, South Africa. Am J Trop Med Hyg. 2008 Apr;78(4):577-85. PMID: 18385352Warren CA, van Opstal EJ, Riggins MS, Li Y, Moore JH, Kolling GL, Guerrant RL, Hoffman PS. Vancomycin treatment's association with delayed intestinal tissue injury, clostridia overgrowth, and recurrence of Clostridium difficile infection in mice. Antimicrob Agents Chemother. 2013 Feb;57(2):689-96. doi: 10.1128/AAC.00877-12. Epub 2012 Nov 12. PMID: 23147742Kolling GL, Wu M, Warren CA, Durmaz E, Klaenhammer TR, Timko MP, Guerrant RL. Lactic acid production by Streptococcus thermophilus alters Clostridium difficile infection and in vitro Toxin A production. Gut Microbes. 2012 Nov-Dec;3(6):523-9. doi: 10.4161/gmic.21757. Epub 2012 Aug 16. Erratum in: Gut Microbes. 2013 Mar-Apr;4(2):175. Timko, Michael P [added]. PMID: 22895082D'Auria KM, Donato GM, Gray MC, Kolling GL, Warren CA, Cave LM, Solga MD, Lannigan JA, Papin JA, Hewlett EL. Systems analysis of the transcriptional response of human ileocecal epithelial cells to Clostridium difficile toxins and effects on cell cycle control. BMC Syst Biol. 2012 Jan 6;6:2. doi: 10.1186/1752-0509-6-2. PMID: 2225989Pawlowski SW, Calabrese G, Kolling GL, Platts-Mills J, Freire R, AlcantaraWarren C, Liu B, Sartor RB, Guerrant RL. Murine model of Clostridium difficile infection with aged gnotobiotic C57BL/6 mice and a BI/NAP1 strain. J Infect Dis. 2010 Dec 1;202(11):1708-12. doi: 10.1086/657086. Epub 2010 Oct 26. Erratum in: J Infect Dis. 2011 May 15;203(10):1505. Platts-Mills, J [added]. PMID: 20977342Mathers AJ, Carroll J, Sifri CD, Hazen KC. Modified Hodge test versus indirect carbapenemase test: prospective evaluation of a phenotypic assay for detection of Klebsiella pneumoniae carbapenemase (KPC) in Enterobacteriaceae. J Clin Microbiol. 2013 Apr;51(4):1291-3. doi: 10.1128/JCM.03240-12. Epub 2013 Feb 6. PMID: 23390272Mathers AJ, Hazen KC, Carroll J, Yeh AJ, Cox HL, Bonomo RA, Sifri CD. First clinical cases of OXA-48-producing carbapenem-resistant Klebsiella pneumoniae in the United States: the "menace" arrives in the new world. J Clin Microbiol. 2013 Feb;51(2):680-3. doi: 10.1128/JCM.02580-12. Epub 2012 Nov 21. PMID: 23175248Mathers AJ, Cox HL, Bonatti H, Kitchel B, Brassinga AK, Wispelwey B, Sawyer RG, Pruett TL, Hazen KC, Patel JB, Sifri CD. Fatal cross infection by carbapenem-resistant Klebsiella in two liver transplant recipients. Transpl Infect Dis. 2009 Jun;11(3):257-65. doi: 10.1111/j.1399-3062.2009.00374.x. Epub 2009 Feb 18. PMID: 19254325Archbald-Pannone L, Sevilleja JE, Guerrant R. Diarrhea, clostridium difficile, and intestinal inflammation in residents of a long-term care facility. J Am Med Dir Assoc. 2010 May;11(4):263-7. doi: 10.1016/j.jamda.2009.09.006. Epub 2010 Mar 15. PMID: 20439046Pawlowski SW, Archbald-Pannone L, Carman RJ, Alcantara-Warren C, Lyerly D, Genheimer CW, Gerding DN, Guerrant RL. Elevated levels of intestinal inflammation in Clostridium difficile infection associated with fluoroquinolone-resistant C. difficile. J Hosp Infect. 2009 Oct;73(2):185-7. doi: 10.1016/j.jhin.2009.05.013. Epub 2009 Aug 26. PMID: 19709778Samie A, Obi CL, Franasiak J, Archbald-Pannone L, Bessong PO, Alcantara-Warren C, Guerrant RL. PCR detection of Clostridium difficile triose phosphate isomerase (tpi), toxin A (tcdA), toxin B (tcdB), binary toxin (cdtA, cdtB), and tcdC genes in Vhembe District, South Africa. Am J Trop Med Hyg. 2008 Apr;78(4):577-85. PMID: 18385352Warren CA, van Opstal EJ, Riggins MS, Li Y, Moore JH, Kolling GL, Guerrant RL, Hoffman PS. Vancomycin treatment's association with delayed intestinal tissue injury, clostridia overgrowth, and recurrence of Clostridium difficile infection in mice. Antimicrob Agents Chemother. 2013 Feb;57(2):689-96. doi: 10.1128/AAC.00877-12. Epub 2012 Nov 12. PMID: 23147742Kolling GL, Wu M, Warren CA, Durmaz E, Klaenhammer TR, Timko MP, Guerrant RL. Lactic acid production by Streptococcus thermophilus alters Clostridium difficile infection and in vitro Toxin A production. Gut Microbes. 2012 Nov-Dec;3(6):523-9. doi: 10.4161/gmic.21757. Epub 2012 Aug 16. Erratum in: Gut Microbes. 2013 Mar-Apr;4(2):175. Timko, Michael P [added]. PMID: 22895082D'Auria KM, Donato GM, Gray MC, Kolling GL, Warren CA, Cave LM, Solga MD, Lannigan JA, Papin JA, Hewlett EL. Systems analysis of the transcriptional response of human ileocecal epithelial cells to Clostridium difficile toxins and effects on cell cycle control. BMC Syst Biol. 2012 Jan 6;6:2. doi: 10.1186/1752-0509-6-2. PMID: 2225989Pawlowski SW, Calabrese G, Kolling GL, Platts-Mills J, Freire R, AlcantaraWarren C, Liu B, Sartor RB, Guerrant RL. Murine model of Clostridium difficile infection with aged gnotobiotic C57BL/6 mice and a BI/NAP1 strain. J Infect Dis. 2010 Dec 1;202(11):1708-12. doi: 10.1086/657086. Epub 2010 Oct 26. Erratum in: J Infect Dis. 2011 May 15;203(10):1505. Platts-Mills, J [added]. PMID: 20977342Mathers AJ, Carroll J, Sifri CD, Hazen KC. Modified Hodge test versus indirect carbapenemase test: prospective evaluation of a phenotypic assay for detection of Klebsiella pneumoniae carbapenemase (KPC) in Enterobacteriaceae. J Clin Microbiol. 2013 Apr;51(4):1291-3. doi: 10.1128/JCM.03240-12. Epub 2013 Feb 6. PMID: 23390272Mathers AJ, Hazen KC, Carroll J, Yeh AJ, Cox HL, Bonomo RA, Sifri CD. First clinical cases of OXA-48-producing carbapenem-resistant Klebsiella pneumoniae in the United States: the "menace" arrives in the new world. J Clin Microbiol. 2013 Feb;51(2):680-3. doi: 10.1128/JCM.02580-12. Epub 2012 Nov 21. PMID: 23175248Mathers AJ, Cox HL, Bonatti H, Kitchel B, Brassinga AK, Wispelwey B, Sawyer RG, Pruett TL, Hazen KC, Patel JB, Sifri CD. Fatal cross infection by carbapenem-resistant Klebsiella in two liver transplant recipients. Transpl Infect Dis. 2009 Jun;11(3):257-65. doi: 10.1111/j.1399-3062.2009.00374.x. Epub 2009 Feb 18. PMID: 19254325

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