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A Gut Check: Altering the GI Microbiome to Fight the <em>C diff</em> Invasion—Case 1: 47-Year-Old Female Patient With Diarrhea and Suspected <em>C diff</em> Infection

A Gut Check: Altering the GI Microbiome to Fight the C diff Invasion—Case 1: 47-Year-Old Female Patient With Diarrhea and Suspected C diff Infection


Patient Case Study

Time to Complete

30 minutes


September 30, 2019


September 30, 2020
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Maximum Credits

0.50 / AMA PRA Category 1 Credit(s)TM

Accredited Provider

Provided by The American Gastroenterological Association (AGA)

Commercial Supporter

This activity is supported by educational funding provided by Merck & Co., Inc.


Produced by Haymarket Medical Education (HME)

Program Description

Clostridioides difficile (C diff) is a leading cause of healthcare-associated infections in the United States. Long associated primarily with hospitalizations, C diff infection (CDI) is becoming more common in non-acute settings. Contributors to the increasing incidence of CDI include the emergence of a virulent C diff strain, increased use of broader spectrum antibiotics, poor antimicrobial stewardship, and continuous use of proton pump inhibitors. Early, accurate diagnosis of CDI is important for both disease management and prevention of outbreaks; updated, evidence-based guidelines recommend use of a multistep algorithm for CDI diagnosis rather than relying on any single test.

Part of a larger myCMETM educational series, this activity features discussion of a female patient who presents with diarrhea and recent antibiotic use; CDI is suspected. Risk factors for the infection will be reviewed, as will the impact of mild to moderate disease. Evidence-based strategies for making a definitive diagnosis of CDI in this patient will be reviewed, including a discussion of updated recommendations for C diff testing put forth by the Infectious Diseases Society of America (IDSA)/Society for Healthcare Epidemiology of America (SHEA). The critical need to distinguish infection with C diff from colonization will be explored, as will the importance of good antibiotic stewardship in the prevention and treatment of CDI.

Intended Audience

Gastroenterologists, infectious disease specialists, hospitalists, and primary care clinicians (MDs/DOs, nurse practitioners [NPs], and physician assistants [PAs])

Educational Objectives

At the conclusion of this activity, participants should be better able to:

  • Identify patients with symptoms of Clostridioides difficile infection (CDI)
  • Make a definitive diagnosis of CDI via appropriate assay analysis

Conflict Of Interest Disclosure Policies

In accordance with the ACCME’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute will implement mechanisms to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.


David G. Binion, MD
Professor of Medicine, Clinical and Translational Science
University of Pittsburgh
Co-Director, IBD Center
Director, Translational IBD Research
Director, Nutrition Support Service
Medical Director, Small Intestinal Transplantation
UPMC Presbyterian Hospital
Pittsburgh, PA

Dr. Binion is a consultant for AbbVie Inc. and UCB Pharma and has received grant/research funding from Merck & Co., Inc., Shire, Takeda Pharmaceuticals, and UCB Pharma.

Accredited Provider Disclosures

The AGA Institute and HME staff involved in the planning and content review of this activity have no relevant financial relationships to disclose.




AMA PRA Category 1 Credit(s)TM

Accreditation Statement

The AGA Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement

The AGA Institute designates this enduring material for a maximum of 0.50 AMA PRA Category 1 CreditTM .  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Additional Credit Information

Physician Assistant Continuing Education
AAPA accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM   from organizations accredited by ACCME or a recognized state medical society. PAs may receive a maximum of 0.50 Category 1 Credit for completing this activity.

Nurse Practitioner Continuing Education
AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM   from organizations accredited by ACCME. Individuals are responsible for checking with the AANPCP for further guidelines.

Disclosure of Unlabeled Use

This educational activity may contain discussion of approved and/or investigational uses of agents that are not indicated by the FDA. AGA, Merck & Co., Inc., and HME 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 AGA, Merck & Co., Inc., or HME. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


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 patients' conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

If you have any questions relating to the accreditation of this activity, please contact the AGA Institute.

If you have any questions relating to your certificate or other issues with the activity, please contact


To obtain credit, a score of 70% or better on the post-test is required. This activity is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the post-test and evaluation, and have received a digital copy of your credit certificate. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.

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