C. difficile infection in IBD: Insights into risk based management

Ciarán Kelly, MD

Professor of Medicine
Harvard Medical School
Director Gastroenterology Fellowship Training
Beth Israel Deaconess Medical Center
Boston, MA

Biography

Ciarán P. Kelly is Professor of Medicine at Harvard Medical School, and Director of Gastroenterology Fellowship Training at Beth Israel Deaconess Medical Center, in Boston, MA. Dr. Kelly earned his medical degree from Trinity College in Dublin, Ireland, where he was a Foundation Scholar and recipient of numerous academic awards. Dr. Kelly has also received postgraduate clinical and research awards from the Crohn's and Colitis Foundation of America (CCFA), the American Gastroenterological Association (AGA), and the National Institutes of Health (NIH). He is an American Gastroenterology Association Fellow, and a Fellow of the American College of Gastroenterology.

Dr. Kelly has longstanding clinical and research interests in intestinal infection and inflammation. He has been involved in patient care and research in Clostridium difficile infection for more than 20 years and leads NIH-funded research programs on the immune response to C. difficile infection, and on potential C. difficile vaccines and other immune-based treatments. He has also completed several studies examining the mechanisms of action of probiotics in C. difficile infection and in antibiotic-associated diarrhea.

Dr. Kelly has served as a committee member of the NIH, Center for Scientific Review, as well as FDA, CDC, and NIH committees related to initiatives to prevent and treat C. difficile infection. Dr. Kelly is the author of more than 200 clinical and basic science research book chapters, invited reviews, and peer-reviewed original publications appearing in journals that include Gastroenterology, Journal of Biological Chemistry, Journal of Clinical Investigation, New England Journal of Medicine and Lancet.

Close Biography

Program overview

C. difficile infection (CDI) is common in patients with IBD, and outcomes are poor when compared to those patients without IBD. Guidelines for CDI recommend therapy based on symptoms/severity at presentation; however, it is also possible to score patients according to risk in terms of adverse outcomes or recurrence. Clinical characteristics associated with recurrent CDI include concomitant diseases such as IBD. Patients with moderate or severe CDI, with a poor prognosis and high risk of recurrence, may benefit from therapies other than the standard guideline recommended "first line" options. Emerging management options, including novel therapies and techniques, may also have a role in serious recurrent CDI, after consideration of the risks and benefits of therapy.

This practice pointer will explore approaches to the risk-based management of CDI and consider whether certain patients populations, in particular those with IBD, may benefit from therapy associated with a lower risk of recurrence. The clinical application of this information will also be considered.

Target audience

This activity has been designed to meet the educational needs of gastroenterologists and registered nurses involved in the care of patients with inflammatory bowel disease (IBD).

Release date: August 25, 2016
Expiry date: August 25, 2017

Learning objectives

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

  • Evaluate risk of poor outcomes of C. difficile infection in patients with IBD
  • Evaluate the risk of recurrence with currently approved therapies for C. difficile
  • Identify opportunities for a "risk based" approach to management of C. difficile infection in patients with IBD
  • Discuss how investigational therapies that target C. difficile toxins and strategies, such as fecal microbiota transplantation, may change this management paradigm.

Disclosure of conflicts of interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. 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:

Name of Faculty or Presenter

Reported Financial Relationship

Ciarán Kelly

Royalty: UpToDate

Fees for non-CME services: Merck, Seres Therapeutics

Consulting fees: Merck, Seres Therapeutics, Summit

Contracted research: Entera Health, Merck


The planners and managers reported the following financial relationships or relationships they or their spouse/life partner have with commercial interests related to the content of this continuing education activity:

The following PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, RN, BSN, and Jan Schultz, RN, MSN, CHCP, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

The following SCI planners and managers, Ian Morgan, MSc, and Elena Urso, BSc, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity or any amount during the past 12 months.

Physician continuing education

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 Postgraduate Institute for Medicine and Strategic Consultants International. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit designation

The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing continuing education

Credit designation

This educational activity for 0.8 contact hours is provided by Postgraduate Institute for Medicine.

Accreditation statement

Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Estimated time to complete activity: 45 minutes

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. The planners of this activity 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 the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

How to obtain credit

There are no fees for participating and receiving CME/CE credit for this activity. To successfully earn credit, participants must complete the activity online during the valid credit period. Follow these steps to earn CME/CE credit:

  1. Read the target audience, learning objectives, and author disclosures
  2. Study the online educational content (can also be printed)
  3. Once the activity is complete, complete the online posttest, and the online evaluation.

Upon successful completion of the posttest, with a passing score of 75% or better, and the online Evaluation form, you will have immediate access to a CME/CE certificate to print or save for your files. We strongly encourage you to complete the Activity Evaluation to provide your feedback for future programming.

If you have any questions regarding the CME/CE certification for this activity, please contact Postgraduate Institute for Medicine at: information@pimed.com or (303) 799-1930.

Media: Internet

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.

This activity is jointly provided by Postgraduate Institute for Medicine
and Strategic Consultants International
PIM Logo  
This activity is supported by an independent educational grant from
Merck Sharp & Dohme Corp.