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A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
Published on: May 25, 2017
Practice Variations in the Management of Clostridioides difficile Infection: Findings From a Survey of US Physicians
Abhishek Deshpande1,2, Elizabeth L Hohmann3, Chelsea Burns4
1Department of Medical Education, Alice L. Walton School of Medicine, Bentonville, Arkansas.
Insights
Physician adherence to Clostridioides difficile infection (CDI) guidelines varies by specialty, with differing treatment preferences. Greater education on CDI management and microbiome therapies is needed for consistent patient care.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Primary Care Medicine
Background:
- Conflicting 2021 guidelines for Clostridioides difficile infection (CDI) management were issued by major medical societies.
- Physician awareness and adherence to these guidelines can impact patient outcomes.
- Gut microbiome therapies are emerging as a potential treatment for recurrent CDI.
Purpose of the Study:
- To assess US gastroenterologists (GIs), infectious disease (ID) specialists, and primary care physicians' (PCPs) use of CDI clinical guidelines.
- To evaluate physician attitudes toward gut microbial therapies for CDI management.
- To identify gaps in knowledge and practice regarding CDI diagnosis and treatment.
Main Methods:
- An online survey was conducted from February 24 to March 13, 2023, involving 302 physicians (101 GIs, 101 IDs, 100 PCPs).
- Participants reported their monthly patient volume for CDI and their current clinical practices.
- Survey questions addressed guideline familiarity, diagnostic approaches, treatment choices, and views on microbiome therapies.
Main Results:
- Gastroenterologists and infectious disease specialists demonstrated higher familiarity with and adherence to CDI guidelines compared to PCPs.
- Significant differences were observed in diagnostic testing strategies and prescribed treatments (e.g., vancomycin taper, fidaxomicin vs. metronidazole).
- Physician knowledge regarding donor-derived microbiome therapies was limited, with a strong demand for real-world safety and efficacy data.
Conclusions:
- Inconsistent application of CDI diagnostic and treatment guidelines necessitates targeted educational interventions.
- Standardized algorithms for CDI testing and management are crucial for improving patient care.
- Further research and evidence generation are required to facilitate the integration of microbiome-based therapies into clinical practice.
Background And Aims:
In 2021, the American College of Gastroenterology and Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America released guidelines for Clostridioides difficile infection (CDI) management, with conflicting recommendations. We surveyed US gastroenterologists (GIs), infectious disease (ID) specialists, and primary care physicians (PCPs) on their use of clinical guidelines and attitudes toward gut microbial therapies for CDI.
Methods:
We conducted an online survey of 302 physicians (n = 101 GIs, 101 IDs, 100 PCPs; February 24 to March 13, 2023). Included GIs and IDs saw a minimum of 3 to 4 patients and PCPs 1 to 2 patients with CDI per month.
Results:
Physicians working in hospital/academic settings were more familiar with CDI guidelines than those working in independent/group practices. Half of GIs used American College of Gastroenterology guidelines; 98% of IDs followed Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines. More PCPs reported that their institutions did not have set guidelines (40%). More GIs (51%) and IDs (74%) used the recommended multistep algorithm for CDI testing; PCPs were more likely to use a single diagnostic test (49%). GIs and IDs more often prescribed vancomycin taper (93% and 98%, respectively) and fidaxomicin (87% and 97%, respectively); PCPs were more likely to prescribe metronidazole (84%). Less than 10% of physicians felt very knowledgeable about donor-derived microbiome therapies. While 60% of GIs, 53% of IDs, and 50% of PCPs agreed donor-derived microbiome therapies are essential for CDI management, more than 50% cited the need for real-world evidence of safety and efficacy.
Conclusion:
Education around CDI guidelines and standardized diagnostic and treatment algorithms are needed to ensure consistent CDI management.
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