Bringing Awareness to Clostridioides difficile and Reviewing the Typical Treatment Regimen

In an effort to bring more awareness to Clostridioides difficile, Gil Melmed, MD, gastroenterologist, Cedars Sinai, Los Angeles, breaks down the typical treatment regimen for this patient population, reviews treatment guidelines, and identifies challenges linked with this condition that health systems, providers, and patients often face. 

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Welcome back to PopHealth Perspectives, a conversation with the population health learning network where we combine expert commentary and exclusive insight into key issues in population health management and more.

Today we are joined by Gil Melmed, gastroenterologist at Cedars-Sinai in Los Angeles. In an effort to bring more awareness to the C. difficile conversation, Dr Melmed breaks down the typical treatment regimen for this patient population, reviews treatment guidelines, and identifies challenges linked with this condition that health systems, providers, and patients often face. Dr Melmed?

Hi, my name is Gil Melmed. I'm a gastroenterologist at Cedars-Sinai in Los Angeles. I codirect our Inflammatory Bowel Disease unit and have been involved in clinical research programs in GI for several years now.

Today, our aim is to bring a bit more awareness to the C. diff conversation. Can you talk a little bit about the challenges in treating this, and what is the typical treatment regimen for these patients?

C. difficile infection presents a major challenge to health care systems, practitioners, and patients. C. diff infection is a very common healthcare-acquired infection. It's a bacteria that can cause diarrhea with a whole spectrum of severity that can include severe colitis, sepsis, and even death, depending on the degree of involvement and how it's affecting an individual patient.

There's guidelines that have been developed as far as the treatment of C. difficile, ranging from mild treatment, that is treating it with outpatient antibiotics, to patients who may require a hospitalization and treatment with antibiotics and both oral and IV intravenous formulations.

There's now monoclonal antibody treatment for recurrent C. difficile. There's also fecal transplants, which can be used for patients with recurrent C. difficile as well or with patients who have very severe C. diff, which is now administered under enforcement discretion with guidance from the FDA.

I will say that, as far as the impact and the burden of C. difficile, C. diff has a tremendous burden. In addition to the individual burden on the individual patient whose life may really be compromised by C. difficile, both in terms of morbidity and mortality, it's a common infection. It's an expensive infection. Patients with C. difficile who are hospitalized have worse outcomes.

They have higher rates of readmission after discharge from the hospital, higher rates of mortality, higher rates of colectomy, than similar patients in the hospital setting who do not have C. difficile, as well as sepsis and associated ICU stays. There's a very significant morbidity and cost factor associated with C. difficile infection as well.

What are some common misconceptions linked with C. diff?

For most people who have heard of someone with C. diff, it might not have been so severe. I think that there may be a misperception out there that C. difficile is always mild. There needs to be awareness that C. difficile can be severe to the point of requiring hospitalization, even ICU stay, and an emergency colectomy or even death. That's often underappreciated.

Another misconception around C. difficile is, isn't so much a misconception, but it's having it on the radar for somebody, for example, who may have chronic diarrhea, and recognizing that this is something that needs to be checked. If you don't check it, you don't find it.

Given the significant morbidity associated with C. difficile, it behooves practitioners to have the awareness of it in order to make sure that it's appropriately assessed. There's different ways of assessing for C. difficile and understanding what those ways are so that an appropriate diagnosis can be reached in a timely fashion.

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