Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective.
| Title: | Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective. |
|---|---|
| Authors: | Hocking L; RAND Europe, Cambridge, United Kingdom.; Wilcox M; School of Medicine, University of Leeds, Leeds, United Kingdom.; Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.; Petrosillo N; Policlinico Universitario, Bio-Medico Campus University Hospital, Rome, Italy.; Griffin P; Mater Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.; Steiner T; Division of Infectious Diseases, The University of British Columbia, Vancouver, BC, Canada.; Attara G; Canadian Society of Intestinal Research, Vancouver, BC, Canada.; Gastrointestinal Society, Vancouver, BC, Canada.; Doré J; INRAE, MetaGenoPolis, AgroParisTech, Micalis Institute, Université Paris-Saclay, Jouy-en-Josas, France.; Cabling M; RAND Europe, Cambridge, United Kingdom.; Stockwell S; RAND Europe, Cambridge, United Kingdom.; Romanelli RJ; RAND Europe, Cambridge, United Kingdom.; Marjanovic S; RAND Europe, Cambridge, United Kingdom. |
| Source: | Frontiers in medicine [Front Med (Lausanne)] 2023 Jan 12; Vol. 9, pp. 1033417. Date of Electronic Publication: 2023 Jan 12 (Print Publication: 2022). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Frontiers Media S.A Country of Publication: Switzerland NLM ID: 101648047 Publication Model: eCollection Cited Medium: Print ISSN: 2296-858X (Print) Linking ISSN: 2296858X NLM ISO Abbreviation: Front Med (Lausanne) Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: Lausanne, Switzerland : Frontiers Media S.A., [2014]- |
| Abstract: | Introduction: Arriving at a C. difficile infection (CDI) diagnosis, treating patients and dealing with recurrences is not straightforward, but a comprehensive and well-rounded understanding of what is needed to improve patient care is lacking. This manuscript addresses the paucity of multidisciplinary perspectives that consider clinical practice related and healthcare system-related challenges to optimizing care delivery.; Methods: We draw on narrative review, consultations with clinical experts and patient representatives, and a survey of 95 clinical and microbiology experts from the UK, France, Italy, Australia and Canada, adding novel multi-method evidence to the knowledge base.; Results and Discussion: We examine the patient pathway and variations in clinical practice and identify, synthesize insights on and discuss associated challenges. Examples of key challenges include the need to conduct multiple tests for a conclusive diagnosis, treatment side-effects, the cost of some antibiotics and barriers to access of fecal microbiota transplantation, difficulties in distinguishing recurrence from new infection, workforce capacity constraints to effective monitoring of patients on treatment and of recurrence, and ascertaining whether a patient has been cured. We also identify key opportunities and priorities for improving patient care that target both clinical practice and the wider healthcare system. While there is some variety across surveyed countries' healthcare systems, there is also strong agreement on some priorities. Key improvement actions seen as priorities by at least half of survey respondents in at least three of the five surveyed countries include: developing innovative products for both preventing (Canada, Australia, UK, Italy, and France) and treating (Canada, Australia, and Italy) recurrences; facilitating more multidisciplinary patient care (UK, Australia, and France); updating diagnosis and treatment guidelines (Australia, Canada, and UK); and educating and supporting professionals in primary care (Italy, UK, Canada, and Australia) and those in secondary care who are not CDI experts (Italy, Australia, and France) on identifying symptoms and managing patients. Finally, we discuss key evidence gaps for a future research agenda.; (Copyright © 2023 Hocking, Wilcox, Petrosillo, Griffin, Steiner, Attara, Doré, Cabling, Stockwell, Romanelli and Marjanovic.) |
| Competing Interests: | NP received fees as speaker and scientific board member from Pfizer, Tillotts, MSD, GSK, Becton & Dickinson, and ImmuneMed. MW has received consulting fees from AiCuris, Bayer, Crestone, Da Volterra, Deinove, EnteroBiotix, The European Tissue Symposium, Ferring Pharmaceuticals, GSK, Menarini, Merck, Nestlé, Paion, Paratek, Pfizer, Phico Therapeutics, Qpex Biopharma, Seres, Surface Skins, Summit, Tillotts, Vaxxilon/Idorsia, and Vedanta; lecture fees from GSK, Merck, Pfizer, Seres, and Tillotts; and grant support from Almirall, Da Volterra, EnteroBiotix, GSK, Merck, MicroPharm, Nabriva, Paratek, Pfizer, Seres, Summit, The European Tissue Symposium, and Tillotts. He is an author of: 2010, 2017, and 2021 IDSA CDI guidelines, 2013 Public Health England CDI guidelines, 2014, 2016 and 2021 ESCMID (treatment and diagnosis) CDI guidelines. He was an expert witness to the 2021 UK National Institute for Clinical Excellence (NICE) CDI treatment guideline. PG Speaker Honoraria includes Seqirus, Novartis, Gilead, Sanofi, and Janssen. His Medical Advisory Board Memberships include AstraZeneca, GSK, MSD, and Pfizer. TS has received funding from Seres, Rebiotix, Merck, and Nubiyota for studies related to C. difficile. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. |
| References: | Patient Prefer Adherence. 2020 Jan 06;14:33-43. (PMID: 32021115); World J Emerg Surg. 2019 Feb 28;14:8. (PMID: 30858872); J Microbiol Methods. 2021 May;184:106189. (PMID: 33689797); Clin Infect Dis. 2012 Aug;55 Suppl 2:S88-92. (PMID: 22752870); Ann Med. 2020 Feb - Mar;52(1-2):12-20. (PMID: 31801387); JAMA Intern Med. 2015 Nov;175(11):1792-801. (PMID: 26348734); Infection. 2019 Dec;47(6):899-909. (PMID: 31428991); J Intern Med. 2021 Aug;290(2):294-309. (PMID: 33856727); Pathogens. 2020 Apr 16;9(4):. (PMID: 32316346); Clin Infect Dis. 2018 Mar 19;66(7):e1-e48. (PMID: 29462280); J Glob Health. 2019 Jun;9(1):010407. (PMID: 30603078); Anaerobe. 2020 Feb;61:102098. (PMID: 31493500); Adv Exp Med Biol. 2018;1050:27-44. (PMID: 29383662); Intern Med J. 2016 Apr;46(4):479-93. (PMID: 27062204); Health Econ Rev. 2021 Jan 13;11(1):3. (PMID: 33439367); Med Mal Infect. 2019 May;49(3):173-179. (PMID: 30266433); Rev Esp Quimioter. 2018 Sep;31 Suppl 1:27-31. (PMID: 30209919); Nurs Stand. 2014 Apr 16-22;28(33):37-43. (PMID: 24734836); Eur J Clin Microbiol Infect Dis. 2016 Dec;35(12):1949-1956. (PMID: 27590621); Antibiotics (Basel). 2021 Mar 13;10(3):. (PMID: 33805755); Int J Clin Pharm. 2020 Jun;42(3):923-930. (PMID: 32410207); Int J Infect Dis. 2015 Jul;36:31-8. (PMID: 26003403); Anaerobe. 2021 Aug;70:102380. (PMID: 33971317); Drug Res (Stuttg). 2019 Apr;69(4):194-200. (PMID: 30193396); J Eval Clin Pract. 2015 Dec;21(6):1199-204. (PMID: 26123092); Eur J Clin Microbiol Infect Dis. 2019 Jul;38(7):1211-1221. (PMID: 30945014); Med Mal Infect. 2016 May;46(3):131-9. (PMID: 27039068); J Clin Microbiol. 2017 Mar;55(3):670-680. (PMID: 28077697); Anaerobe. 2018 Feb;49:103-111. (PMID: 29309845); Antimicrob Resist Infect Control. 2012 May 30;1(1):20. (PMID: 22958425); Gastroenterology Res. 2013 Oct;6(5):171-173. (PMID: 27785249); Lancet Infect Dis. 2014 Dec;14(12):1208-19. (PMID: 25455988); Med Mal Infect. 2018 Feb;48(1):23-29. (PMID: 29336929); Therap Adv Gastroenterol. 2021 May 30;14:17562848211018654. (PMID: 34104214); J Pediatr Gastroenterol Nutr. 2016 Dec;63(6):e130-e140. (PMID: 27182626); J Clin Med. 2021 Jan 20;10(3):. (PMID: 33498428); Clin Colon Rectal Surg. 2020 Mar;33(2):73-81. (PMID: 32104159); Adv Exp Med Biol. 2018;1050:117-135. (PMID: 29383667); BMJ. 2019 Aug 20;366:l4609. (PMID: 31431428); J Antimicrob Chemother. 2018 Oct 1;73(10):2851-2855. (PMID: 29982502); Anaerobe. 2020 Apr;62:102108. (PMID: 31606481); Clin Microbiol Infect. 2021 Dec;27 Suppl 2:S1-S21. (PMID: 34678515); J Hosp Infect. 2010 Apr;74(4):309-18. (PMID: 20153547) |
| Contributed Indexing: | Keywords: C. difficile infection; Clostridioides difficile; Clostridium difficile; healthcare improvement; healthcare systems; patient pathway |
| Entry Date(s): | Date Created: 20230130 Latest Revision: 20231103 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC9877614 |
| DOI: | 10.3389/fmed.2022.1033417 |
| PMID: | 36714122 |
| Database: | MEDLINE |
Journal Article