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Welcome Program Information Accreditation Instructions for Credit Disclosures The Past, Present, and Future Clostridium difficile-Associated Disease Rates of CDAD Tripled in US Hospitals Annual VHA Discharges with C. difficile Epidemics VHA CDAD Rates by Age CDAD Rates and Mortality Rates* of C. difficile Enterocolitis as Underlying Cause of Death on US Death Certificates Pathogenicity of C. difficile Toxigenic and Non-Toxigenic C. difficile Strains Typing Systems/Nomenclature for Possible Virulence Factors States with the Epidemic Strain of C. difficile Outbreak Strains Are NOT New: Comparison of Host Protection Against CDAD Role of Antibiotics in CDAD Time-Course of Antimicrobial Effect Hypothesis for C. difficile Hospital Infection Reduced Risk of CDAD in Patients Asymptomatic Commentary from the Field Prevention: Patient Risk Factors Clostridium difficile (CD) Colitis: Background CD Epidemiology CD in Hospitals CD in Hospitals CD in Hospitals Previously Described Risk Factors Changing Epidemiology and New Risk Factors Antibiotic Trend Analysis Results University of Pittsburgh Medical Center (UPMC) Matched Case-Control Study Results Matched Case-Control Study Results Matched Case-Control Study Results Matched Case-Control Study Results Independent Antibiotic Risk Factors Independent Antibiotic Risk Factors Risk of CDAD According to Antibiotic Class Risk of CDAD According to Antibiotic Class Retrospective Cohort Study CDAD and Gastric Acid Suppression Environmental and Skin Contamination Environmental and Skin Contamination Environmental and Skin Contamination Environmental and Skin Contamination Environmental and Skin Contamination Environmental and Skin Contamination Undefined Risks: Four States, 2005 Infection Control Preventative Measures Infection Control Preventative Measures Infection Control Preventative Measures Infection Control Measures Johnson S et al. Am J Med. 1990;88:137-40. Johnson S et al. Am J Med. 1990;88:137-40. ** different from AHR and AHW (P<0.05); * different from AHR (P<0.05) ** different from AHR and AHW (P<0.05); * different from AHR (P<0.05) Isolation and Barrier Precautions Effect of Environmental Disinfection Effect of Environmental Disinfection Sporulation and the Epidemic Strain Bookmark 141 Bookmark 142 Sporulation and the Epidemic Strain The UPMC CD Bundle HA CDAD rate began increasing HA CDAD rate began increasing Enhanced Infection Control Measures Contact Precautions Increased Case Finding and Early Identification Informatics Tools CDAD Management Team CDAD Management Team Other CDAD Management Issues Other CDAD Management Issues Targeted Antibiotic Restriction Targeted Antibiotic Restriction Fluoroquinolone and Clindamycin Usage 102 and 74 genotypes were analyzed by MLVA in 2001 and 2005, respectively 102 and 74 genotypes were analyzed by MLVA in 2001 and 2005, respectively 102 and 74 genotypes were analyzed by MLVA in 2001 and 2005, respectively 102 and 74 genotypes were analyzed by MLVA in 2001 and 2005, respectively 102 and 74 genotypes were analyzed by MLVA in 2001 and 2005, respectively 102 and 74 genotypes were analyzed by MLVA in 2001 and 2005, respectively 102 and 74 genotypes were analyzed by MLVA in 2001 and 2005, respectively 102 and 74 genotypes were analyzed by MLVA in 2001 and 2005, respectively UPMC CD HAI and Severe Disease UPMC CD HAI and Severe Disease UPMC CD HAI and Severe Disease UPMC CD HAI and Severe Disease UPMC CD HAI and Severe Disease UPMC CD HAI and Severe Disease Conclusions Close Close Close Close Close Commentary from the Field Minimizing Risk Through Outline of Presentation Early Cases of Probable CDAD Case Series of Clindamycin Colitis Many Case Reports of Pseudomembranous Antibiotics and CDAD: Complexity of Linking Antibiotic Use to CDAD Complexity of Linking Antibiotic Use to CDAD Meta-analysis of the Risk of C. difficile Infection Meta-analysis of the Risk of C. difficile Infection Difficulties in Comparing Investigations Which Antibiotic Is Most Likely to Cause CDAD? Mean Changes in Antibiotic Use Fluoroquinolone Use in Brief History of Quinolones and CDAD Formulary Fluoroquinolones and CDAD Formulary Fluoroquinolones and CDAD (cont d) Evaluation of CDAD with a Drug Formulary Quinolone Antibiotics and CDAD Stewardship and CDAD Stewardship and CDAD (cont d) Stewardship and CDAD (cont d) Changes in Targeted Antibiotics and CDAD Changes in Targeted Antibiotics and CDAD Many Remaining Questions Summary Addressing Today s Crisis C. difficile-Associated Disease Aslam S et al. Lancet Infect Dis. 2005;5:549-57. Vancomycin vs Metronidazole for CDAD: Potential Strategies to Improve CDAD Treatment Clinical Investigational Therapies for CDAD In vitro MICs Against 110 Unique International Tolevamer Severity of CDAD Tolevamer Phase III Results: OPT- 80 for CDAD Rifaximin for CDAD Nitazoxanide for CDAD Nitazoxanide for CDAD Investigational Prevention and Treatment Special CDAD Treatments Dilated Loops of Colon in a Patient with CDAD Fulminant CDAD: WBC and Hospital Course Bookmark 111 Leukocytosis and CDAD Do Not Miss Management of Fulminant or Management of Fulminant CDAD Treatment of First Recurrence of CDAD Treatment of Multiple CDAD Recurrences Management of Multiple Recurrences Intravenous Immunoglobulin (IVIG) for Treatment of CDAD: Commentary from the Field Ask the Faculty Thank you Thank you