C. Difficile Infection

James Pile, MD, and Glenn Wortmann, MD
Supported by an educational grant from Merck & Co Inc.
Clostridium difficile (C. difficile) is a Gram-positive, toxin-producing, anaerobic bacillus, which is commonly responsible for antibiotic-associated diarrhea. An estimated 500 000 cases occur each year in the United States, and the incidence and severity of disease appear to be increasing. The morbidity of C. difficile infection (CDI) has risen by as much as 25% per year, and a 20-fold increase in mortality has been reported. Human transmission is through the fecal-oral route, and CDI has become the most frequently reported hospital-acquired infection, with nosocomial acquisition more than quadrupling the cost of hospitalization. Diagnosis of patients with CDI should be made based on clinical grounds in conjunction with stool testing, with the caveat that current diagnostic strategies remain imperfect. Although effective treatment is available, approximately 20% of patients suffer relapse after an initial infection; those patients with multiple prior infections face a 60% recurrence risk. Emerging therapeutics are being developed and may revolutionize therapy. Hospitalists should be knowledgeable about the clinical presentation of CDI and therapies based on disease severity. In addition, awareness of treatment strategies for patients with recurrent infections and emerging treatment options will help practitioners manage this complex disease.
To provide hospitalists with current data and guidelines regarding the diagnosis and treatment of hospitalized patients with CDI.
This activity is designed for hospitalists and residents interested in the field of consultative medicine. No prerequisites required.
After completing the module, the participant should be able to:
IDENTIFY risk factors associated with C. difficile infection.
DISCUSS current options for the laboratory diagnosis of C. difficile infection, including strengths and limitations of each.
DESCRIBE the therapeutic options for C. difficile infection, based on disease severity.
OUTLINE the factors associated with recurrent C. difficile infection.
IDENTIFY potential treatment strategies for recurrent C. difficile infection, including their limitations.
DEMONSTRATE familiarity with new horizons in the prevention and treatment of C. difficile infection.
Accreditation Statement:
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of University of Virginia School of Medicine, ASiM and Society of Hospital Medicine. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation Statement:
The University of Virginia School of Medicine designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits.TM Physicians should claim only the credit commensurate with the extent of their participation in the activity. 
Release date: April 26, 2016 Expiration date: April 26, 2019 
Estimated time to complete activity: 2 hours
Full Disclosure Policy Affecting CME Activities:
The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.
The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.
All faculty presenters participating in an accredited CME activity are expected to disclose relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the participant. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.
The faculty and staff of the University of Virginia Office of Continuing Medical Education have no financial affiliations to disclose.
The following relationships have been reported for faculty of this activity: 
Leonard Feldman, MD, FACP, FAAP, SFHM (Chair) 
Assistant Professor of Medicine and Pediatrics 
Johns Hopkins University School of Medicine 
Medicine-Pediatrics Urban Health Residency Program Director
Associate Program Director, Osler Internal Medical Residency
Director, Comprehensive General Medicine Consult Service
Editor, Consultative and Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland
Dr Feldman reports having no significant financial or advisory relationships with corporate organizations related to this activity.
James Pile, MD, SFHM, FACP
Vice Chair for Faculty Development, Department of Hospital Medicine
Vice Chair for Professional Staff Affairs, Medicine Institute
Cleveland Clinic
Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Cleveland, Ohio
Dr Pile reports serving on the advisory committee/board for Cempra.
Glenn Wortmann, MD, FIDSA, FACP
Section Chief and Program Director, Infectious Diseases
MedStar Washington Hospital Center, Washington, DC
Professor of Clinical Medicine (Infectious Diseases)
Georgetown University
Washington, DC
Dr Wortmann reports serving on a speakers’ bureau, as a faculty member, or peer reviewer for Astellas Pharma Inc; and serving on an advisory committee/board for Sanofi.
Cirle Alcantara Warren, MD, FACP (Peer Reviewer)
Associate Professor of Medicine
Division of Infectious Disease and International Health
University of Virginia
Charlottesville, Virginia
Dr Warren reports having no significant financial or advisory relationships with corporate organizations related to this activity.
The staff at ASiM reports having no significant financial or advisory relationships with corporate organizations related to this activity. 
Disclosure of Discussion of Non-FDA–Approved Uses for Pharmaceutical Products and/or Medical Devices
The University of Virginia School of Medicine, as an ACCME provider, requires that all faculty presenters identify and disclose any off-label uses for pharmaceutical and medical device products. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.
All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

The opinions and recommendations expressed by faculty and other experts are based on current scientific evidence and standards of care and their professional expertise. This enduring material is produced for educational purposes only. The University of Virginia School of Medicine implements specific educational planning processes to ensure that content is patient-centric and independent. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.
Click here  to download the references for this educational activity.
The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: a non-designated pre-test, a study program, and a CME post-test. All 3 sections must be completed to receive CME credit.
Course summary
Available credit: 
  • 2.00 AMA PRA Category 1 Credit™
Course opens: 
Course expires: 
Your cost:

Available Credit

  • 2.00 AMA PRA Category 1 Credit™


Your cost:
Please login or register to take this course.