Contagion

Clostridioides Difficile Pathogenesis & Manifestation

Managing Recurrent Clostridium Difficile Infections

RBX2660 for Recurrent Clostridioides Difficile

Antibiotic Microbial Resistance & RBX7455 for C Diff

Clostridioides Difficile: Exciting Developments

Videos

Paradigm Shift in the Management of Clostridium Difficile Infections

Debra Goff, PharmD, describes the success of a community outreach approach to spreading the word about antimicrobial stewardship among dentists and orthopedic surgeons.

Interview Transcript (modified slightly for readability):

We did a unique approach, community outreach. My husband is a private practice dentist, my neighbor is an internal medicine physician that works for the largest orthopedic surgery practice in town, and also is head of all the nursing homes so he has a relationship with all the orthopedic surgeons. 

And they really applied to dental stewardship what I call handshake stewardship. They called their friends and said we need to get together. We had an evening program, we invited the CDC [US Centers for Disease Control and Prevention] who's responsible for outpatient stewardship in our country. And together I worked with an ID physician that does stewardship with me. 

We prepared about a one-hour didactic presentation on bringing the physicians in attendance and dentists up to speed on community rates of antibiotic resistance, which they were not aware of, the consequences of prescribing antibiotics and adverse events and some of those consequences being contributing to antibiotic resistance in our community. And also the development of C diff [Clostridiodes difficile], many had no idea could actually die from C diff. We brought them up to speed on recent data in our own community.

The CDC brought the perspective of the need for outpatient stewardship from a global and national perspective. Then we broke them up into working groups, dentists and orthopedic surgeons, we developed patient cases, and they had to see if they could come to a consensus on the antibiotic prophylaxis need. We gave them 10 thought-provoking questions to try to understand how they came to their answers.

Then they presented to the group and it was just amazing when they meet face to face, it's a little different than when you're talking to people over a phone call. Now I know you and I understand your thought process. They were actually able to come to consensus. And one orthopedic surgeon actually said, "We reviewed this case. If you asked me yesterday, I would have said antibiotic prophylaxis before a dental procedure for life. But I learned new information today. And we came to an agreement, no antibiotic prophylaxis for this patient." That was huge. By really meeting each other, handshake stewardship, it actually works.

Community Outreach for Dental Antibiotic Stewardship

Gregory Felzien, MD, AAHIVS, medical advisor, Division of Health Protection, Georgia Department of Public Health, discusses the surprising benefits clinics encounter when they enhance community engagement.

Interview transcript: (modified slightly for readability)

I'm really excited about this poster that we've presented. First off, having organizations like Prime Education supporting these types of projects because they are so, so important. I think there a couple of things that we have to think about that are real big takeaways, like the willingness for these facilities to be involved in a project like this, because a lot of times when you tell a facility we'd like to do a project there's a lot of pushback, “we don't have time we don't have space. This seems like a lot of effort. And we're not going to be able to participate.”

And we've had some really good facilities really want to be involved in this, and not just see it as a project with an end of presenting something at the end, but really being able to create action plans and bringing community together.

Many times what we see is we have administrators or the physician themselves in a clinic say, “well, I know what's best for this clinic. These are the changes we're going to make moving forward,” and not involve the rest of the staff or make sure they're involving the community. And that's what this study did. It really brought these different factors together.

The other big takeaway is, to really see that there are gaps and perceptions between the clinic providers and the community that they serve. In one instance, one of the clinic staff made the statement that “you know, we have bus passes, we have gas vouchers, we have Lyft. We have Uber. We have all these ways getting individuals to the clinic. So transportation shouldn't be an issue.” But on the community side in the survey, one of the top 3 issues was transportation. So there's a disconnect.

What the great thing was is that facility really thought about this and said, “okay, we're going to create an action plan to improve this.” So you can imagine if I'm in a rural community, then they say, “oh, we're going to use one of these new ways of transportation.” The car pulls up, I recognize the car—it might be a relative, somebody I go to church with&mdash;I'm not going to get in that car, because they're going to take me to a place where suddenly I'm disclosing my status or my lifestyle.

I think really, what a study like this does is a couple of things. A lot of these facilities have limited resources and where do we start to improve systems and flows? Well doing a study like this really can prioritize where that funding can go and where those resources can go to make improvements. The other big takeaway that can be really exciting with this is it's not just a single effort, meaning that you can look at what the top 3 or 4 gaps are in improving flow and systems and then repeat the same study again in 6 months, 12 months down the road, to see were there improvements, do there need to be additional changes? I think this can be an ongoing quality in continuing to make improvements and making sure individuals can access care.

Gregory Felzien, MD, discusses the surprising benefits HIV clinics encounter when they enhance community engagement.
 

HIV Clinic Improvement and Community Engagement

We’ve rounded up a list of important recalls issued by the US Food and Drug Administration (FDA) and the US Department of Agriculture (USDA) from this past week:

Vegetable Trays Tied with Multistate Outbreak of 

Del Monte Fresh Produce N.A., Inc. ("Del Monte Fresh") announced today, the voluntary recall of a limited quantity of 6 oz., 12 oz. and 28 oz. vegetable trays containing fresh broccoli, cauliflower, celery sticks, carrots, and dill dip sold to select retailers in Illinois, Indiana, Iowa, Michigan, Minnesota, and Wisconsin.

Del Monte has recalled the products because they may be linked to this recent cluster of illnesses and have the potential to be contaminated with 

, a parasite that can cause the intestinal illness cyclosporiasis.

For the most recent case counts associated with the outbreak, be sure to check out the 

For more information, check out the official 

Raw Ground Beef Products Recalled Due to Potential Contamination with Shiga Toxin-Producing 

Texas Natural Meats, a Lott, Texas establishment, is recalling approximately 489 pounds of frozen raw, ground beef products that may be contaminated with Shiga toxin-producing 

(STEC) O103, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The products subject to recall bear establishment number “EST. 34449” inside the USDA mark of inspection. These items were shipped to a retailer who sold the product at a farmer’s market in Roger, Texas.

For more information about STEC O103 and the recall, read the official 

Zesty Sprouting Mix Recalled Due to Possible 

NOW Health Group, Inc. recently issued a recall for its NOW Real Food® Zesty Sprouting Mix — Product Code 7271, Lot #3031259 and Lot #3038165 as its primary ingredient, Crimson Clover Seeds, may be contaminated with 

Approximately 10,000 units of Zesty Sprouting Mix were distributed online and in retail stores nationwide since December 2017.

Gaia Ethnobontanical, LLC Recalls Kratom Products Linked to Salmonella

Gaia Ethnobotanical, LLC., has issued a voluntary recall for all kratom (

) powder products, with Lot No.: 0102031800 

 manufactured, processed, packed, and/or held, between March 18, 

 to the consumer level. The recall was issued after sample testing conducted by the FDA detected 

The affected products (listed below) can be identified by Lot No.: 0102031800 and Batch No.: 031800. Specifically, the products were distributed to several states throughout the country.

This recall comes after a recent multistate 

 linked to kratom was deemed resolved by the Centers for Disease Control and Prevention.

For the complete list of recalled kratom products, read the official 

Beef Pastrami Products Recalled Due to Possible Underprocessing

Agri Star Meat and Poultry LLC has recalled approximately 3,592 pounds of ready-to-eat (RTE) beef pastrami products due to processing deviations that may have led to underprocessing of products and resulted in inadequate curing, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The RTE beef pastrami items were produced on April 3 and April 4, 2018. The products subject to recall bear establishment number “EST. 4653A” inside the USDA mark of inspection. These items were shipped to distributors in California, Florida, Illinois, New York and Washington.

Articles

In case you missed them, we’ve compiled a list of the latest recalls posted this week.