The Colossal Impact of Clostridium Difficile Infection

Introduction amp Epidemiology

Introduction amp Epidemiology

Introduction amp Epidemiology

Health officials now rank C diff on par with MRSA

as one of the top two infections acquired in hospitals

bull Decreasing Prevalence of CDI at the

NAH since the launch of

Antimicrobial Stewardship Program

Switch over to PCR- Lab testing amp

Tighter Infection Control measures

National average is 7ndash26 among

adult inpatients in acute care facilities

Courtesy

Syed Ali

Laboratory Director

Debbie Graham

Infection Control

Jillian Baranggay

Quality Improvement

Case Definition of CDI

Measurement Outcome

Categorize Cases by location and time

of onsetdagger

Admission Discharge

lt 4 weeks 4-12 weeks

HO CO-HCFA Indeterminate CA-CDI

Time

2 d gt 12 weeks

HO Hospital (Healthcare)-Onset

CO-HCFA Community-Onset Healthcare Facility-Associated

CA Community -Associated

Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA

dagger Onset defined in NHSN LabID Event by specimen collection date

Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5

Day 1 Day 4

Standardized Case Definitions for Surveillance

Sunenshine et al Cleve Clin J Med 200673187-97

Pathogenesis of CDI

4 Toxin A amp B Production

leads to colon damage

+- pseudomembrane

1 Ingestion

of spores transmitted

from other patients

via the hands of healthcare

personnel and environment

2 Germination into

growing (Vegetative)

Form)

3 Altered lower intestine flora

(due to antimicrobial use) allows

proliferation of

C difficile in colon

Risk Factors of CDI

Risk Factors of CDI

Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)

NAP1

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Introduction amp Epidemiology

Introduction amp Epidemiology

Introduction amp Epidemiology

Health officials now rank C diff on par with MRSA

as one of the top two infections acquired in hospitals

bull Decreasing Prevalence of CDI at the

NAH since the launch of

Antimicrobial Stewardship Program

Switch over to PCR- Lab testing amp

Tighter Infection Control measures

National average is 7ndash26 among

adult inpatients in acute care facilities

Courtesy

Syed Ali

Laboratory Director

Debbie Graham

Infection Control

Jillian Baranggay

Quality Improvement

Case Definition of CDI

Measurement Outcome

Categorize Cases by location and time

of onsetdagger

Admission Discharge

lt 4 weeks 4-12 weeks

HO CO-HCFA Indeterminate CA-CDI

Time

2 d gt 12 weeks

HO Hospital (Healthcare)-Onset

CO-HCFA Community-Onset Healthcare Facility-Associated

CA Community -Associated

Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA

dagger Onset defined in NHSN LabID Event by specimen collection date

Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5

Day 1 Day 4

Standardized Case Definitions for Surveillance

Sunenshine et al Cleve Clin J Med 200673187-97

Pathogenesis of CDI

4 Toxin A amp B Production

leads to colon damage

+- pseudomembrane

1 Ingestion

of spores transmitted

from other patients

via the hands of healthcare

personnel and environment

2 Germination into

growing (Vegetative)

Form)

3 Altered lower intestine flora

(due to antimicrobial use) allows

proliferation of

C difficile in colon

Risk Factors of CDI

Risk Factors of CDI

Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)

NAP1

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Introduction amp Epidemiology

Introduction amp Epidemiology

Health officials now rank C diff on par with MRSA

as one of the top two infections acquired in hospitals

bull Decreasing Prevalence of CDI at the

NAH since the launch of

Antimicrobial Stewardship Program

Switch over to PCR- Lab testing amp

Tighter Infection Control measures

National average is 7ndash26 among

adult inpatients in acute care facilities

Courtesy

Syed Ali

Laboratory Director

Debbie Graham

Infection Control

Jillian Baranggay

Quality Improvement

Case Definition of CDI

Measurement Outcome

Categorize Cases by location and time

of onsetdagger

Admission Discharge

lt 4 weeks 4-12 weeks

HO CO-HCFA Indeterminate CA-CDI

Time

2 d gt 12 weeks

HO Hospital (Healthcare)-Onset

CO-HCFA Community-Onset Healthcare Facility-Associated

CA Community -Associated

Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA

dagger Onset defined in NHSN LabID Event by specimen collection date

Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5

Day 1 Day 4

Standardized Case Definitions for Surveillance

Sunenshine et al Cleve Clin J Med 200673187-97

Pathogenesis of CDI

4 Toxin A amp B Production

leads to colon damage

+- pseudomembrane

1 Ingestion

of spores transmitted

from other patients

via the hands of healthcare

personnel and environment

2 Germination into

growing (Vegetative)

Form)

3 Altered lower intestine flora

(due to antimicrobial use) allows

proliferation of

C difficile in colon

Risk Factors of CDI

Risk Factors of CDI

Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)

NAP1

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Introduction amp Epidemiology

Health officials now rank C diff on par with MRSA

as one of the top two infections acquired in hospitals

bull Decreasing Prevalence of CDI at the

NAH since the launch of

Antimicrobial Stewardship Program

Switch over to PCR- Lab testing amp

Tighter Infection Control measures

National average is 7ndash26 among

adult inpatients in acute care facilities

Courtesy

Syed Ali

Laboratory Director

Debbie Graham

Infection Control

Jillian Baranggay

Quality Improvement

Case Definition of CDI

Measurement Outcome

Categorize Cases by location and time

of onsetdagger

Admission Discharge

lt 4 weeks 4-12 weeks

HO CO-HCFA Indeterminate CA-CDI

Time

2 d gt 12 weeks

HO Hospital (Healthcare)-Onset

CO-HCFA Community-Onset Healthcare Facility-Associated

CA Community -Associated

Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA

dagger Onset defined in NHSN LabID Event by specimen collection date

Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5

Day 1 Day 4

Standardized Case Definitions for Surveillance

Sunenshine et al Cleve Clin J Med 200673187-97

Pathogenesis of CDI

4 Toxin A amp B Production

leads to colon damage

+- pseudomembrane

1 Ingestion

of spores transmitted

from other patients

via the hands of healthcare

personnel and environment

2 Germination into

growing (Vegetative)

Form)

3 Altered lower intestine flora

(due to antimicrobial use) allows

proliferation of

C difficile in colon

Risk Factors of CDI

Risk Factors of CDI

Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)

NAP1

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

bull Decreasing Prevalence of CDI at the

NAH since the launch of

Antimicrobial Stewardship Program

Switch over to PCR- Lab testing amp

Tighter Infection Control measures

National average is 7ndash26 among

adult inpatients in acute care facilities

Courtesy

Syed Ali

Laboratory Director

Debbie Graham

Infection Control

Jillian Baranggay

Quality Improvement

Case Definition of CDI

Measurement Outcome

Categorize Cases by location and time

of onsetdagger

Admission Discharge

lt 4 weeks 4-12 weeks

HO CO-HCFA Indeterminate CA-CDI

Time

2 d gt 12 weeks

HO Hospital (Healthcare)-Onset

CO-HCFA Community-Onset Healthcare Facility-Associated

CA Community -Associated

Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA

dagger Onset defined in NHSN LabID Event by specimen collection date

Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5

Day 1 Day 4

Standardized Case Definitions for Surveillance

Sunenshine et al Cleve Clin J Med 200673187-97

Pathogenesis of CDI

4 Toxin A amp B Production

leads to colon damage

+- pseudomembrane

1 Ingestion

of spores transmitted

from other patients

via the hands of healthcare

personnel and environment

2 Germination into

growing (Vegetative)

Form)

3 Altered lower intestine flora

(due to antimicrobial use) allows

proliferation of

C difficile in colon

Risk Factors of CDI

Risk Factors of CDI

Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)

NAP1

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Case Definition of CDI

Measurement Outcome

Categorize Cases by location and time

of onsetdagger

Admission Discharge

lt 4 weeks 4-12 weeks

HO CO-HCFA Indeterminate CA-CDI

Time

2 d gt 12 weeks

HO Hospital (Healthcare)-Onset

CO-HCFA Community-Onset Healthcare Facility-Associated

CA Community -Associated

Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA

dagger Onset defined in NHSN LabID Event by specimen collection date

Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5

Day 1 Day 4

Standardized Case Definitions for Surveillance

Sunenshine et al Cleve Clin J Med 200673187-97

Pathogenesis of CDI

4 Toxin A amp B Production

leads to colon damage

+- pseudomembrane

1 Ingestion

of spores transmitted

from other patients

via the hands of healthcare

personnel and environment

2 Germination into

growing (Vegetative)

Form)

3 Altered lower intestine flora

(due to antimicrobial use) allows

proliferation of

C difficile in colon

Risk Factors of CDI

Risk Factors of CDI

Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)

NAP1

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Measurement Outcome

Categorize Cases by location and time

of onsetdagger

Admission Discharge

lt 4 weeks 4-12 weeks

HO CO-HCFA Indeterminate CA-CDI

Time

2 d gt 12 weeks

HO Hospital (Healthcare)-Onset

CO-HCFA Community-Onset Healthcare Facility-Associated

CA Community -Associated

Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA

dagger Onset defined in NHSN LabID Event by specimen collection date

Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5

Day 1 Day 4

Standardized Case Definitions for Surveillance

Sunenshine et al Cleve Clin J Med 200673187-97

Pathogenesis of CDI

4 Toxin A amp B Production

leads to colon damage

+- pseudomembrane

1 Ingestion

of spores transmitted

from other patients

via the hands of healthcare

personnel and environment

2 Germination into

growing (Vegetative)

Form)

3 Altered lower intestine flora

(due to antimicrobial use) allows

proliferation of

C difficile in colon

Risk Factors of CDI

Risk Factors of CDI

Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)

NAP1

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Sunenshine et al Cleve Clin J Med 200673187-97

Pathogenesis of CDI

4 Toxin A amp B Production

leads to colon damage

+- pseudomembrane

1 Ingestion

of spores transmitted

from other patients

via the hands of healthcare

personnel and environment

2 Germination into

growing (Vegetative)

Form)

3 Altered lower intestine flora

(due to antimicrobial use) allows

proliferation of

C difficile in colon

Risk Factors of CDI

Risk Factors of CDI

Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)

NAP1

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Risk Factors of CDI

Risk Factors of CDI

Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)

NAP1

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Risk Factors of CDI

Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)

NAP1

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)

NAP1

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

C diffrsquo Detectives Track a Murderous Global Microbe

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Routes of Transmission Epidemiology of Colonization and Infection

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Clinical Manifestations

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Clinical Manifestations

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

DiagnosisWhat is the Best Testing Strategy to Diagnose CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

DiagnosisSpecimen Collection and Transport

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Diagnosis of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Diagnosis of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

CT Findings bullbowel wall thickening (most common)

bullCT equivalent to thumbprinting

bullaccordion sign

bullshaggy mucosal outline

bullpericolic stranding

bullperitoneal free fluid

bullalthough typically the whole colon is

involved the right colon and transverse colon

may be affected in isolation in up to 5 of

cases 2

bullrectal involvement in the vast majority of

cases (90-95)

Management of CDI

Treatment of CDISurgical options

Oral Vancomycin Taper In managing multiple

relapsers

It consists of 125 mg four times

daily for 14 days

then 125 mg bid for 7 days 125

mg once daily for 7 days 125

mg once every other day for 8

days and finally

125 mg once every 3 days for

15 days

Cost Comparison

Additional amp Adjuvant Therapy

bull Fidaxomicin

bull Rifaximin or Rifampin-

bull Nitazoxanide

bull Monoclonal antibodies-

bull Intravenous immune globulin (IVIG)

Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)

Use of Probiotics

Infection Control and PreventionSurveillance amp Tracking

Core Prevention Strategies

httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92

Oral Vancomycin Taper In managing multiple

relapsers

It consists of 125 mg four times

daily for 14 days

then 125 mg bid for 7 days 125

mg once daily for 7 days 125

mg once every other day for 8

days and finally

125 mg once every 3 days for

15 days

Cost Comparison

Additional amp Adjuvant Therapy

bull Fidaxomicin

bull Rifaximin or Rifampin-

bull Nitazoxanide

bull Monoclonal antibodies-

bull Intravenous immune globulin (IVIG)

Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)

Use of Probiotics

Infection Control and PreventionSurveillance amp Tracking

Core Prevention Strategies

httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92

Cost Comparison

Additional amp Adjuvant Therapy

bull Fidaxomicin

bull Rifaximin or Rifampin-

bull Nitazoxanide

bull Monoclonal antibodies-

bull Intravenous immune globulin (IVIG)

Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)

Use of Probiotics

Infection Control and PreventionSurveillance amp Tracking

Core Prevention Strategies

httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92

Additional amp Adjuvant Therapy

bull Fidaxomicin

bull Rifaximin or Rifampin-

bull Nitazoxanide

bull Monoclonal antibodies-

bull Intravenous immune globulin (IVIG)

Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)

Use of Probiotics

Infection Control and PreventionSurveillance amp Tracking

Core Prevention Strategies

httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92

Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)

Use of Probiotics

Infection Control and PreventionSurveillance amp Tracking

Core Prevention Strategies

httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92

Use of Probiotics

Infection Control and PreventionSurveillance amp Tracking

Core Prevention Strategies

httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92

Infection Control and PreventionSurveillance amp Tracking

Core Prevention Strategies

httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92

Core Prevention Strategies

httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92

Prevention Strategies Supplemental

C difficile can survive on a dry surface for 60 days

Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores

Infection Control = Antimicrobial Control

Antimicrobial Stewardship ProgramNorwegian American Hospital

Implement Evidence-Based Practices to Prevent Emergence

amp Improve Management of C Difficile Infection

Antibiogram

1

62

5

27

58

1

Discontinue Redundant Coverage

Add Appropriate Cover for Culture

Narrow Spectrum of Activity

Discontinued with AntibioticPrescription

IV to PO Switch Made

Dosing Changed

ID Consult Suggested

Antimicrobial StewardshipInterventions Performed

Antimicrobial Stewardship

Intervention Acceptance Rates

94

6

0

10

20

30

40

50

60

70

80

90

100

Annual Totals

RecommendedInterventionsPerformed

RecommendedInterventions notPerformed

Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept

Days of Doses Dispensed Continuation of Therapy

Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept

Improvement in the Treatment of Clostridium Difficile Infection

Issues Identified

bull Lab

bull Pharmacy

bull Physicians

Interventions Implemented

bull Lab

bull Pharmacy

bull Physicians

References

httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml

httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment

httpjamajamanetworkcomarticleaspxarticleid=1916296

httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454

Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH

Infection Control = Antimicrobial Control

Antimicrobial Stewardship ProgramNorwegian American Hospital

Implement Evidence-Based Practices to Prevent Emergence

amp Improve Management of C Difficile Infection

Antibiogram

1

62

5

27

58

1

Discontinue Redundant Coverage

Add Appropriate Cover for Culture

Narrow Spectrum of Activity

Discontinued with AntibioticPrescription

IV to PO Switch Made

Dosing Changed

ID Consult Suggested

Antimicrobial StewardshipInterventions Performed

Antimicrobial Stewardship

Intervention Acceptance Rates

94

6

0

10

20

30

40

50

60

70

80

90

100

Annual Totals

RecommendedInterventionsPerformed

RecommendedInterventions notPerformed

Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept

Days of Doses Dispensed Continuation of Therapy

Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept

Improvement in the Treatment of Clostridium Difficile Infection

Issues Identified

bull Lab

bull Pharmacy

bull Physicians

Interventions Implemented

bull Lab

bull Pharmacy

bull Physicians

References

httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml

httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment

httpjamajamanetworkcomarticleaspxarticleid=1916296

httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454

Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH

Antimicrobial Stewardship ProgramNorwegian American Hospital

Implement Evidence-Based Practices to Prevent Emergence

amp Improve Management of C Difficile Infection

Antibiogram

1

62

5

27

58

1

Discontinue Redundant Coverage

Add Appropriate Cover for Culture

Narrow Spectrum of Activity

Discontinued with AntibioticPrescription

IV to PO Switch Made

Dosing Changed

ID Consult Suggested

Antimicrobial StewardshipInterventions Performed

Antimicrobial Stewardship

Intervention Acceptance Rates

94

6

0

10

20

30

40

50

60

70

80

90

100

Annual Totals

RecommendedInterventionsPerformed

RecommendedInterventions notPerformed

Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept

Days of Doses Dispensed Continuation of Therapy

Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept

Improvement in the Treatment of Clostridium Difficile Infection

Issues Identified

bull Lab

bull Pharmacy

bull Physicians

Interventions Implemented

bull Lab

bull Pharmacy

bull Physicians

References

httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml

httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment

httpjamajamanetworkcomarticleaspxarticleid=1916296

httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454

Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH

Antibiogram

1

62

5

27

58

1

Discontinue Redundant Coverage

Add Appropriate Cover for Culture

Narrow Spectrum of Activity

Discontinued with AntibioticPrescription

IV to PO Switch Made

Dosing Changed

ID Consult Suggested

Antimicrobial StewardshipInterventions Performed

Antimicrobial Stewardship

Intervention Acceptance Rates

94

6

0

10

20

30

40

50

60

70

80

90

100

Annual Totals

RecommendedInterventionsPerformed

RecommendedInterventions notPerformed

Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept

Days of Doses Dispensed Continuation of Therapy

Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept

Improvement in the Treatment of Clostridium Difficile Infection

Issues Identified

bull Lab

bull Pharmacy

bull Physicians

Interventions Implemented

bull Lab

bull Pharmacy

bull Physicians

References

httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml

httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment

httpjamajamanetworkcomarticleaspxarticleid=1916296

httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454

Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH

1

62

5

27

58

1

Discontinue Redundant Coverage

Add Appropriate Cover for Culture

Narrow Spectrum of Activity

Discontinued with AntibioticPrescription

IV to PO Switch Made

Dosing Changed

ID Consult Suggested

Antimicrobial StewardshipInterventions Performed

Antimicrobial Stewardship

Intervention Acceptance Rates

94

6

0

10

20

30

40

50

60

70

80

90

100

Annual Totals

RecommendedInterventionsPerformed

RecommendedInterventions notPerformed

Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept

Days of Doses Dispensed Continuation of Therapy

Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept

Improvement in the Treatment of Clostridium Difficile Infection

Issues Identified

bull Lab

bull Pharmacy

bull Physicians

Interventions Implemented

bull Lab

bull Pharmacy

bull Physicians

References

httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml

httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment

httpjamajamanetworkcomarticleaspxarticleid=1916296

httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454

Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH

Days of Doses Dispensed Continuation of Therapy

Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept

Improvement in the Treatment of Clostridium Difficile Infection

Issues Identified

bull Lab

bull Pharmacy

bull Physicians

Interventions Implemented

bull Lab

bull Pharmacy

bull Physicians

References

httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml

httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment

httpjamajamanetworkcomarticleaspxarticleid=1916296

httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454

Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH

Improvement in the Treatment of Clostridium Difficile Infection

Issues Identified

bull Lab

bull Pharmacy

bull Physicians

Interventions Implemented

bull Lab

bull Pharmacy

bull Physicians

References

httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml

httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment

httpjamajamanetworkcomarticleaspxarticleid=1916296

httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454

Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH

References

httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml

httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment

httpjamajamanetworkcomarticleaspxarticleid=1916296

httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454

Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH