Clostridium difficile: Changing Diagnosis, Epidemiology, and Treatment

OVERVIEW
This free activity, entitled “Clostridium difficile: Changing Diagnosis, Epidemiology, and Treatment,” consists of three Lecture Presentations, a Learning Assessment, and an Evaluation form. The content of this virtual lecture is derived from a satellite symposium presented on April 7, 2008, during the 18th Annual SHEA Scientific Meeting.

MEDIUM: Virtual Lecture
LIVE RELEASE DATE: April 7, 2008
INTERNET RELEASE DATE: May 19, 2008
Continuing education credit is no longer available for this activity.

Estimated time to complete this activity: 2 hours

TARGET AUDIENCE
This virtual lecture is designed to meet the educational needs of physicians, pharmacists, and registered nurses involved in the care of patients with Clostridium difficile infection.

ACTIVITY PURPOSE
This virtual lecture is intended to assist physicians, pharmacists, and registered nurses in understanding how to manage patients with Clostridium difficile infection.

STATEMENT OF NEED
In recent years, the rates and severity of Clostridium difficile infection have been increasing.1 This trend may be the result of changes in the epidemiology of C. difficile, which may arise from changes in antimicrobial use, other drug-prescribing practices, or infection control practices.2 The increasing rates of C. difficile infection may also be the result of a new strain of C. difficile, one that appears to produce greater quantities of toxins A and B, is more resistant to fluoroquinolones, and is associated with higher rates of morbidity and mortality.3,4 Healthcare professionals should be aware of the changing epidemiology of this increasingly virulent pathogen and apply evidence-based principles for the diagnosis and treatment of C. difficile infection.

¹ McDonald LC, et al. Emerg Infect Dis. 2006;12:409-415.
² Centers for Disease Control and Prevention. Fact Sheet, July 2005.
³ Warny M, et al. Lancet. 2005;366:1079-1084.
⁴ McDonald LC, et al. N Engl J Med. 2005;353:2433-2441.

EDUCATIONAL OBJECTIVES
After completing this activity, the participant should be better able to:

Cite the changing epidemiology of C. difficile
Explain the potential mechanisms and characteristics of the virulent strain of C. difficile
Describe clinical and laboratory findings important for the diagnosis of C. difficile infection
Identify current treatment strategies for C. difficile infection

METHOD OF PARTICIPATION
There are no fees for participating and receiving CME credit for this activity. During the period April 7, 2008, through May 31, 2009, participants must 1) read the learning objectives and faculty disclosures; 2) study the educational activity; 3) complete the post-test by recording the best answer to each question on the Learning Assessment page; 4) complete the Evaluation Form; and 5) mail, fax or electronically submit the Evaluation form to Postgraduate Institute for Medicine.

Participants must receive a score of at least 70% on the Learning Assessment and must complete and submit the Evaluation form to successfully complete this activity. Participants who successfully complete this activity will be issued a statement of credit via email or US mail within 4 weeks.

NOTE: Attendees of the live symposium held at the Buena Vista Palace in Orlando, Florida, in April 2008, are not permitted to participate in this activity and cannot receive credit.

PHYSICIAN CONTINUING EDUCATION

ACCREDITATION STATEMENT
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM) and Robert Michael Educational Institute LLC (RMEI). PIM is accredited by the ACCME to provide continuing medical education for physicians.

CREDIT DESIGNATION
Postgraduate Institute for Medicine designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

INTERNATIONAL PHYSICIANS
International physicians completing this activity will receive a certificate documenting participation in an activity designated for AMA PRA Category 1 Credit™. International physicians should contact their respective licensure and certification bodies for information on use/conversion of AMA PRA Category 1 Credit(s)™.

PHARMACIST CONTINUING EDUCATION

ACCREDITATION STATEMENT
Postgraduate Institute for Medicine is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

CREDIT DESIGNATION
Postgraduate Institute for Medicine designates this continuing education activity for 2.0 contact hours
(0.2 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Program Number 809-999-08-014-H01-P).

A statement of credit will be issued only upon receipt of a completed activity Evaluation form and will be mailed to you within 4 to 6 weeks.

NURSING CONTINUING EDUCATION

CNA/ANCC
This educational activity for 2.0 contact hours is provided by Postgraduate Institute for Medicine (PIM).

PIM is an approved provider of continuing nursing education by the Colorado Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

CALIFORNIA BOARD OF REGISTERED NURSING
Postgraduate Institute for Medicine is approved by the California Board of Registered Nursing, Provider Number 13485 for 2.4 contact hours.

FACULTY
Dale N. Gerding, MD, FIDSA
Dale N. Gerding, MD, FIDSA, is Professor of Medicine at Loyola University Chicago Stritch School of Medicine in Maywood, Illinois, and Associate Chief of Staff for Research at Hines Veterans Affairs Hospital in Hines, Illinois.

L. Clifford McDonald, MD, FACP, FSHEA
L. Clifford McDonald, MD, is a medical epidemiologist in the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), which has primary responsibility for public health response activities in healthcare settings.

Stuart Johnson, MD, DTM&H
Stuart Johnson, MD, DTM&H, is Associate Professor of Medicine at Loyola University Chicago Stritch School of Medicine in Maywood, Illinois, and a staff physician at the Hines VA Hospital in Hines, Illlinois.

DISCLAIMER
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information and comparison with recommendations of other authorities.

DISCLOSURE OF UNLABELED USE
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM), Robert Michael Educational Institute LLC and ViroPharma Incorporated do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, Robert Michael Educational Institute LLC, or ViroPharma Incorporated. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings.

DISCLOSURE OF CONFLICTS OF INTEREST
Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Dr. Dale N. Gerding has asked that we advise participants in this activity that he has an affiliation with AstraZeneca, Optimer Pharmaceuticals, Inc., Oscient Pharmaceuticals, Romark Laboratories, LC, Salix Pharmaceuticals, Inc. (Consultant); Genzyme Corporation, GOJO Industries, Inc. (Consultant and Research); and ViroPharma Incorporated (Consultant, Research, and Patent Holder).
Dr. L. Clifford McDonald has no affiliations with commercial interests to disclose.
Dr. Stuart Johnson has asked that we advise participants in this activity that he has an affiliation with Acambis, Genzyme Corporation, Romark Laboratories, LC, Salix Pharmaceuticals, Inc., and ViroPharma Incorporated (Consultant).The following planners and managers have the following to disclose:

Robert Michael Educational Institute LLC

Sherri Kramer, MD, has no affiliations with commercial interests to disclose.

Postgraduate Institute for Medicine

Jan Hixon, RN, BSN, MS, has no affiliations with commercial interests to disclose.
Linda Graham, RN, has no affiliations with commercial interests to disclose.
Trace Hutchison, PharmD, has no affiliations with commercial interests to disclose.

FEE INFORMATION
There is no fee for this educational activity.

QUESTIONS & TECHNICAL ASSISTANCE
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity: jjones@pimed.com. For technical assistance, contact jungsen@rmcom.net.

SYSTEM REQUIREMENTS
Hardware/Software requirements include:
• Windows 95, 98se, ME, XP, NT 4.0, 2000
  - Internet Explorer 4.0+
  - Netscape Navigator 6.2+
  - AOL 8
  - Mozilla Firefox 1.0+
• Macintosh 9.2, OS X 10.1+
  - Safari 1.1+
  - Netscape Navigator 6.2+
  - Internet Explorer 5/2+
  - Mozilla Firefox 1.0+
• Additional Requirements
  - Macromedia Flash Player 7
  - Internal/external speakers
  - Broadband connection (DSL/cable) recommended

To see additional educational programming available, visit www.RMEI.com.

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Home	Start Lecture Presentations	Enter Learning Assessment & Evaluation Form	Download Activity Workbook
OVERVIEW This free activity, entitled “Clostridium difficile: Changing Diagnosis, Epidemiology, and Treatment,” consists of three Lecture Presentations, a Learning Assessment, and an Evaluation form. The content of this virtual lecture is derived from a satellite symposium presented on April 7, 2008, during the 18th Annual SHEA Scientific Meeting. MEDIUM: Virtual Lecture LIVE RELEASE DATE: April 7, 2008 INTERNET RELEASE DATE: May 19, 2008 Continuing education credit is no longer available for this activity. Estimated time to complete this activity: 2 hours TARGET AUDIENCE This virtual lecture is designed to meet the educational needs of physicians, pharmacists, and registered nurses involved in the care of patients with Clostridium difficile infection. ACTIVITY PURPOSE This virtual lecture is intended to assist physicians, pharmacists, and registered nurses in understanding how to manage patients with Clostridium difficile infection. STATEMENT OF NEED In recent years, the rates and severity of Clostridium difficile infection have been increasing.1 This trend may be the result of changes in the epidemiology of C. difficile, which may arise from changes in antimicrobial use, other drug-prescribing practices, or infection control practices.2 The increasing rates of C. difficile infection may also be the result of a new strain of C. difficile, one that appears to produce greater quantities of toxins A and B, is more resistant to fluoroquinolones, and is associated with higher rates of morbidity and mortality.3,4 Healthcare professionals should be aware of the changing epidemiology of this increasingly virulent pathogen and apply evidence-based principles for the diagnosis and treatment of C. difficile infection. ¹ McDonald LC, et al. Emerg Infect Dis. 2006;12:409-415. ² Centers for Disease Control and Prevention. Fact Sheet, July 2005. ³ Warny M, et al. Lancet. 2005;366:1079-1084. ⁴ McDonald LC, et al. N Engl J Med. 2005;353:2433-2441. EDUCATIONAL OBJECTIVES After completing this activity, the participant should be better able to: Cite the changing epidemiology of C. difficile Explain the potential mechanisms and characteristics of the virulent strain of C. difficile Describe clinical and laboratory findings important for the diagnosis of C. difficile infection Identify current treatment strategies for C. difficile infection METHOD OF PARTICIPATION There are no fees for participating and receiving CME credit for this activity. During the period April 7, 2008, through May 31, 2009, participants must 1) read the learning objectives and faculty disclosures; 2) study the educational activity; 3) complete the post-test by recording the best answer to each question on the Learning Assessment page; 4) complete the Evaluation Form; and 5) mail, fax or electronically submit the Evaluation form to Postgraduate Institute for Medicine. Participants must receive a score of at least 70% on the Learning Assessment and must complete and submit the Evaluation form to successfully complete this activity. Participants who successfully complete this activity will be issued a statement of credit via email or US mail within 4 weeks. NOTE: Attendees of the live symposium held at the Buena Vista Palace in Orlando, Florida, in April 2008, are not permitted to participate in this activity and cannot receive credit. PHYSICIAN CONTINUING EDUCATION ACCREDITATION STATEMENT This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM) and Robert Michael Educational Institute LLC (RMEI). PIM is accredited by the ACCME to provide continuing medical education for physicians. CREDIT DESIGNATION Postgraduate Institute for Medicine designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. INTERNATIONAL PHYSICIANS International physicians completing this activity will receive a certificate documenting participation in an activity designated for AMA PRA Category 1 Credit™. International physicians should contact their respective licensure and certification bodies for information on use/conversion of AMA PRA Category 1 Credit(s)™. PHARMACIST CONTINUING EDUCATION ACCREDITATION STATEMENT Postgraduate Institute for Medicine is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. CREDIT DESIGNATION Postgraduate Institute for Medicine designates this continuing education activity for 2.0 contact hours (0.2 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Program Number 809-999-08-014-H01-P). A statement of credit will be issued only upon receipt of a completed activity Evaluation form and will be mailed to you within 4 to 6 weeks. NURSING CONTINUING EDUCATION CNA/ANCC This educational activity for 2.0 contact hours is provided by Postgraduate Institute for Medicine (PIM). PIM is an approved provider of continuing nursing education by the Colorado Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. CALIFORNIA BOARD OF REGISTERED NURSING Postgraduate Institute for Medicine is approved by the California Board of Registered Nursing, Provider Number 13485 for 2.4 contact hours. FACULTY Dale N. Gerding, MD, FIDSA Dale N. Gerding, MD, FIDSA, is Professor of Medicine at Loyola University Chicago Stritch School of Medicine in Maywood, Illinois, and Associate Chief of Staff for Research at Hines Veterans Affairs Hospital in Hines, Illinois. L. Clifford McDonald, MD, FACP, FSHEA L. Clifford McDonald, MD, is a medical epidemiologist in the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), which has primary responsibility for public health response activities in healthcare settings. Stuart Johnson, MD, DTM&H Stuart Johnson, MD, DTM&H, is Associate Professor of Medicine at Loyola University Chicago Stritch School of Medicine in Maywood, Illinois, and a staff physician at the Hines VA Hospital in Hines, Illlinois. DISCLAIMER Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information and comparison with recommendations of other authorities. DISCLOSURE OF UNLABELED USE This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM), Robert Michael Educational Institute LLC and ViroPharma Incorporated do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, Robert Michael Educational Institute LLC, or ViroPharma Incorporated. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. DISCLOSURE OF CONFLICTS OF INTEREST Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest. The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity: Dr. Dale N. Gerding has asked that we advise participants in this activity that he has an affiliation with AstraZeneca, Optimer Pharmaceuticals, Inc., Oscient Pharmaceuticals, Romark Laboratories, LC, Salix Pharmaceuticals, Inc. (Consultant); Genzyme Corporation, GOJO Industries, Inc. (Consultant and Research); and ViroPharma Incorporated (Consultant, Research, and Patent Holder). Dr. L. Clifford McDonald has no affiliations with commercial interests to disclose. Dr. Stuart Johnson has asked that we advise participants in this activity that he has an affiliation with Acambis, Genzyme Corporation, Romark Laboratories, LC, Salix Pharmaceuticals, Inc., and ViroPharma Incorporated (Consultant).The following planners and managers have the following to disclose: Robert Michael Educational Institute LLC Sherri Kramer, MD, has no affiliations with commercial interests to disclose. Postgraduate Institute for Medicine Jan Hixon, RN, BSN, MS, has no affiliations with commercial interests to disclose. Linda Graham, RN, has no affiliations with commercial interests to disclose. Trace Hutchison, PharmD, has no affiliations with commercial interests to disclose. FEE INFORMATION There is no fee for this educational activity. QUESTIONS & TECHNICAL ASSISTANCE For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity: jjones@pimed.com. For technical assistance, contact jungsen@rmcom.net. SYSTEM REQUIREMENTS Hardware/Software requirements include: • Windows 95, 98se, ME, XP, NT 4.0, 2000 - Internet Explorer 4.0+ - Netscape Navigator 6.2+ - AOL 8 - Mozilla Firefox 1.0+ • Macintosh 9.2, OS X 10.1+ - Safari 1.1+ - Netscape Navigator 6.2+ - Internet Explorer 5/2+ - Mozilla Firefox 1.0+ • Additional Requirements - Macromedia Flash Player 7 - Internal/external speakers - Broadband connection (DSL/cable) recommended To see additional educational programming available, visit www.RMEI.com. PIM Privacy Policy RMEI Privacy Statement
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