#IDJClub Transcript
Healthcare social media transcript of the #IDJClub hashtag.
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See #IDJClub Influencers/Analytics.
| Profile | Tweet |
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 | ID Journal Club @IDJClub Welcome to our December #IDJClub! Hope everyone had a thankful and fulfilling Thanksgiving. Tonight’s moderator @docwoc71 here & discussing the following article 👇Please use #IDJclub to help us keep track of the conversations. Let’s start with introductions! Who’s joining in? https://t.co/EFTKBHQCvJ |
 | Ilan Schwartz MD PhD @GermHunterMD @Darcy_ID_doc @IDJClub This is also my approach. Would only do if previous recurrent (>1) episodes CDI #IDJClub |
| ID Journal Club @IDJClub The article we are discussing tonight: Johnson SW et al. Effectiveness of PO vanco for prevention of healthcare facility-onset Clostridioides difficile infection in targeted patients during systemic antibiotic exposure. Clin Infect Dis 2019 Sep27 https://t.co/kpaBuRh0CD #IDJClub |
| ID Journal Club @IDJClub This is Laila Woc @DocWoc71 tonight's moderator from @bcmhouston and from the Republic of Texas- No COIs #IDJClub |
 | Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @IDJClub @DocWoc71 Todd McCarty, faculty @UABSOM, no conflicts related to tonight's discussion. #IDJClub |
 | Jordan Chiasson @chiassonIDpharm @IDJClub @DocWoc71 Jordan Chiasson, PharmD; ID Pharmacist at Tulane Medical Center in New Orleans #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 RT @IDJClub: Welcome to our December #IDJClub! Hope everyone had a thankful and fulfilling Thanksgiving. Tonight’s moderator @docwoc71 here & discussing the following article 👇Please use #IDJclub to help us keep track of the conversations. Let’s start with introductions! Who’s joining in? https://t.co/EFTKBHQCvJ |
 | Raj Mehta @raj_mehta Raj Mehta, family doc & clinical informatics. No COI. #IDJClub |
| ID Journal Club @IDJClub Let's start the conversation:This was a randomized, prospective, open-label study at Novant Health Forsyth Medical Center in Winston-Salem, NC Oct2018-Apr2019 in 100 pts.THE ? was to evaluate the effectiveness PO Vanco for the prevention of HCFO-CDI in pts #IDJClub thoughts? |
 | Michael Angarone @mangarone23 Mike Angarone @NM_IDSteward #IDJClub |
 | Jeff Pearson @jeffpears0n @IDJClub @DocWoc71 Jeff Pearson, PharmD up in Boston. No COI, will be in-and-out of journal club tonight, but looking forward to the discussion! #IDJClub |
 | Veronica Zafonte @VBZafonte @IDJClub @DocWoc71 Veronica Zafonte, PharmD. ID Pharmacist at @JamaicaHospital in Queens, NY #IDJClub |
 | Darcy Wooten she/her @Darcy_ID_doc @sebpoule @IDJClub Wow! Interesting it it a policy....#IDJclub |
| Ilan Schwartz MD PhD @GermHunterMD @IDJClub I think its a subject prime for an RCT so a great topic #IDJClub |
 | Sonali Advani MD, MPH, FIDSA @Sonali_Advani @jeffpears0n @IDJClub @DocWoc71 Sonali Advani, MD, MPH Healthcare epidemiologist and ID attending @dukemedicine #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @sebpoule @IDJClub #IDJClub https://t.co/JkN8a75H0y |
| Darcy Wooten she/her @Darcy_ID_doc @IDJClub I wish they would have included people who had had C diff before...these are the folks I would be most worried about #idjclub |
 | Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @IDJClub: To get this 🔥 up Will start with a poll question: To get this 🔥 up Will start with a poll question: who routinely uses oral vanco ppx in patients on broad-spectrum antibiotic ? 🧐 Please comment on the maybe #IDJClub |
| Michael Angarone @mangarone23 @IDJClub Agree this study opens the door for a RCT #IDJclub |
| Ilan Schwartz MD PhD @GermHunterMD @Darcy_ID_doc @IDJClub Could potentially be a smaller study too if that were the case... maybe as a substudy of a larger RCT? #IDJClub |
| ID Journal Club @IDJClub Table1: Summarizes the studies suggest that oral vancomycin prophylaxis may be an option for both 2nd % 1ry prevention of HCFO-CDI These studies showed potential benefit but are limited by their design, reliance, lack of intervention std, & limited risk stratification #IDJClub https://t.co/8EsaWPNOcA |
| ID Journal Club @IDJClub So far our poll has 50% for No #IDJClub |
| Jeff Pearson @jeffpears0n @IDJClub Depends on previous history and antibiotic being given. Definitely not done automatically though #IDJClub |
| Veronica Zafonte @VBZafonte @Darcy_ID_doc @IDJClub I was thinking the same thing. I was surprised that history of CDI wasn't one of the the high risk criteria #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @IDJClub nice to see some Canadian content, @carignan_alex #IDJClub |
| Darcy Wooten she/her @Darcy_ID_doc @IDJClub Great summary table! #idjclub |
| ID Journal Club @IDJClub So these are different retrospective studies done on PO Vanco #IDJClub |
 | Kermit the BLM Liger | he/him | @KermitTheLiger RT @DrFatimaKakkar: Just in time to introduce ID Doc and #MedEd leader and enthusiast @jm_leduc to #IDMedEd and the cool ID folks who make this happen @GermHunterMD @IDdocAdi @Darcy_ID_doc @sebpoule @PedsID4Life @ERistagno |
| ID Journal Club @IDJClub RT @GermHunterMD: @Darcy_ID_doc @IDJClub Could potentially be a smaller study too if that were the case... maybe as a substudy of a larger RCT? #IDJClub |
| ID Journal Club @IDJClub @Darcy_ID_doc Thoughts #IDJClub |
| ID Journal Club @IDJClub @ASP_MirandaS That is one of the limitations of the study no define length #IDJClub |
| Jeff Pearson @jeffpears0n @IDJClub Small study overall, but love seeing the first prospective data in an often-debated subject with only retrospective data up until now #IDJClub |
| Darcy Wooten she/her @Darcy_ID_doc @IDJClub But yes the retrospective studies done before have a ton of bias that is difficult to control for #idjclub |
| ID Journal Club @IDJClub Method:A randomized, prospective, open-label study performed at NHFMC, a 961-bed, 3ry community hospital in Winston-Salem, NC High risk: Age ≥60 yrs, hospitalized ≤30d prior to the index hospitalization, & received systemic antibiotics during that prior hospitalization #IDJClub |
| ID Journal Club @IDJClub @jeffpears0n What are your thoughts on the primary and secondary endpoints #IDJClub |
| Veronica Zafonte @VBZafonte @IDJClub At our institution we consider adding vancomycin PO 125 mg daily in patients with a history of CDI within the previous 6 months who are receiving broad spectrum systemic antibiotics #IDJClub |
| ID Journal Club @IDJClub 2nd Endpoint: total hospital acquisition costs per patient, side effects to OVP, new VRE colonization & incidence of CO-HCFA-CDI after hospital discharge #IDJClub |
| ID Journal Club @IDJClub 1ry endpoint was the incidence of HCFO-CDI. HCFO-CDI was defined as symptoms of loose stools (≥3) or diarrhea in a 24-hour period in patients with concurrent positive test for C. dif PCR, Xpert C. difficile/Epi; Cephied) >72 hrs into hospitalization #IDJClub |
| ID Journal Club @IDJClub @VBZafonte Evidence ? #IDJClub |
| Sonali Advani MD, MPH, FIDSA @Sonali_Advani @ASP_MirandaS @IDJClub Also, they were able to capture less than 50% of these follow-ups by telephone surveys which further limits the sample size #IDJClub |
 | Brad Cutrell, MD, FIDSA @BradCutrellMD @IDJClub One issue with all of these studies is does it really prevent CDI recurrence or just delay its onset since PO vancomycin does affect microbiome as well. Is HCFO-CDI the right outcome to measure or seems you want to measure it for longer duration? #IDJClub |
| ID Journal Club @IDJClub @GermHunterMD @ASP_MirandaS Correct N=100 for pilot and then larger study #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @BradCutrellMD @IDJClub This is the argument made in the editorial... that basically the follow up period was not long enough to know the long term effects of perturbing the gut flora with oral vanco #IDJClub |
 | Indiana University Infectious Diseases Fellowship @IUIDfellowship RT @IDJClub: Table1: Table1: Summarizes the studies suggest that oral vancomycin prophylaxis may be an option for both 2nd % 1ry prevention of HCFO-CDI These studies showed potential benefit but are limited by their design, reliance, lack of intervention std, & limited risk stratification #IDJClub https://t.co/8EsaWPNOcA |
| ID Journal Club @IDJClub @BradCutrellMD Interesting probably a clear endpoint #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @IDJClub I'm a bit suspect of the stool frequency on the lower end. Abx associated diarrhea will easily eclipse that and CDiff colonization is not so rare to worry about some of these being false positives. #IDJClub |
 | Nathan Nolan, MD MPH @NNolanMD Perhaps a silly question, but in regards to interventions that could potentially improve illness, what is the downside to PO vanc? #IDJClub |
| Jeff Pearson @jeffpears0n @IDJClub I'm a big fan of this table! I had all but one of these studies already saved on my Dropbox, but this is an excellent bird's-eye view of the retrospective data when I'm trying to remember which study showed what #IDJClub |
| ID Journal Club @IDJClub @Sonali_Advani @ASP_MirandaS Another limitation but is a start #IDJClub |
 | weskufel @WesKufel RT @IDJClub: Table1: Table1: Summarizes the studies suggest that oral vancomycin prophylaxis may be an option for both 2nd % 1ry prevention of HCFO-CDI These studies showed potential benefit but are limited by their design, reliance, lack of intervention std, & limited risk stratification #IDJClub https://t.co/8EsaWPNOcA |
| ID Journal Club @IDJClub @GermHunterMD @BradCutrellMD Correct #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @Sonali_Advani @ASP_MirandaS @IDJClub Although I think they mitigate this by getting *some* medical record data. A lot of the patients were re-admitted - given the enrolment criteria was 2 admissions within 30 days, not surprising! #IDJClub |
| ID Journal Club @IDJClub @jeffpears0n Excellent #IDJClub |
 | Obi Nnedu, MD @onnnedu @IDJClub Not many studies with once a day dose of oral vanc as prophylaxis #IDJClub |
| ID Journal Club @IDJClub @raj_mehta @VBZafonte @Darcy_ID_doc But that is the point of the secondary prophylaxis right 🧐 #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @onnnedu @IDJClub yes, the dosing they chose was a bit odd, wasn't it #IDJClub |
| ID Journal Club @IDJClub @Cortes_Penfield As you know this is an issue with definitions and why we have change three times testing dx #IDJClub |
| Veronica Zafonte @VBZafonte @IDJClub We used the data from the Van Hise, 2016 study and ran with it. We haven't formally evaluated it, but to my knowledge none of those patients (I would say <50 patients) developed a recurrent CDI episode during their stay🤞 #IDJClub |
| Darcy Wooten she/her @Darcy_ID_doc @Cortes_Penfield @IDJClub I was wondering if it would have been helpful to do PCR on everyone at entry to help sort out the issue of colonization...but not sure it would help #idjclub |
| ID Journal Club @IDJClub @onnnedu Very few #IDJClub |
| Brad Cutrell, MD, FIDSA @BradCutrellMD @GermHunterMD @IDJClub Exactly. To take an extreme example, if you keep everyone on po vancomycin until discharge then you won't have any HCFO-CDI. #IDJClub |
| ID Journal Club @IDJClub @carignan_alex @GermHunterMD What is the biggest barrier to do a prospective study? #IDJClub |
| ID Journal Club @IDJClub @VBZafonte Oh interesting when is being published #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @NNolanMD altered microbiome, increased VRE, increased colonization with antimicrobial resistant organisms down the road (including decreased resistance to CDiff per the editorial) #IDJClub |
| Sonali Advani MD, MPH, FIDSA @Sonali_Advani @NNolanMD gastrointestinal side effects, VRE acquisition #IDJClub - The study looked at this, but not sure if they captured adequate follow-up period |
| ID Journal Club @IDJClub @Darcy_ID_doc @Cortes_Penfield But you would have had many false positives 🧐 #IDJClub |
| ID Journal Club @IDJClub @ASP_MirandaS Yes they are now being used as marker for dysbiosis and microbiome studies @dns_francisco #IDJClub |
 | Joshua Torrance @JoshuaRTorrance @ASP_MirandaS @IDJClub Appreciated that they at least tried to measure development of resistance. Seems like most prophylaxis studies just gloss over it! #IDJClub |
| ID Journal Club @IDJClub Tweet1/3: Table2-: baseline long table N=100 The 2 groups were similar inevaluated baseline and hospitalization characteristics #IDJClub https://t.co/0R0BrKO5fN |
| ID Journal Club @IDJClub @SAIRABT @TMcCarty2010 Not really hard to define Welcome! #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @SAIRABT @IDJClub There was this line from the methods section, they were thinking about it, but how judiciously? #IDJClub https://t.co/i7z8aCzp6J |
| ID Journal Club @IDJClub @cricri22mex @infecto79 Si chico ya estan tarde #IDJClub |
 | Julio C. Zuniga-Moya @JulioCZuniga1 RT @IDJClub: To get this 🔥 up Will start with a poll question: To get this 🔥 up Will start with a poll question: who routinely uses oral vanco ppx in patients on broad-spectrum antibiotic ? 🧐 Please comment on the maybe #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @TMcCarty2010 @SAIRABT @IDJClub Yes, this is a peculiar policy. Sounds like a make work project... not sure how it affects the generalizability of the results #IDJClub |
| Darcy Wooten she/her @Darcy_ID_doc @Boghuma @IDJClub They did not #idjclub |
| Jeff Pearson @jeffpears0n @IDJClub Primary endpoint is appropriate, although it would have been greater to have longer term follow-up (and not just ~50% phone interviews and 85% chart review). We can debate endlessly on the use of diarrhea + PCR to define C.diff #IDJClub |
 | Madeline King-Patel @MK_IDpharm @IDJClub @DocWoc71 Madeline, ID PharmD here, a little late 🤪 #idjclub |
| ID Journal Club @IDJClub @Boghuma In the methods section: Have you been diagnosed by a medical provider with C. difficile infection in the past month since being discharged from the hospital?, Have you had unexplained and new-onset ≥3 unformed stools in a 24-hour period since being dc? #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @BradCutrellMD @IDJClub Would you say there's an argument for using fidaxomicin instead since it seems to be narrower spectrum and similarly has data to suggest less risk of relapse in use of treatment? #IDJClub |
| Darcy Wooten she/her @Darcy_ID_doc @sigal_md @Cortes_Penfield @IDJClub Agreed. Wondering if it could have helped sort out who was colonized from the beginning #idjclub |
| Jeff Pearson @jeffpears0n @GermHunterMD @onnnedu @IDJClub And I love it! Now I can feel a bit more comfortable recommending the lowest effective dose when vanco prophylaxis is brought up #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @Boghuma @IDJClub I did not find a supplement that might have housed this sort of information #IDJClub |
| ID Journal Club @IDJClub @ASP_MirandaS @carignan_alex @GermHunterMD Great ideas for the next one #IDJClub |
| Darcy Wooten she/her @Darcy_ID_doc @sigal_md @Cortes_Penfield @IDJClub But I don’t think c diff pcr has been validated to diagnose colonization...#idjclub |
| Sonali Advani MD, MPH, FIDSA @Sonali_Advani I was just about to post this. I wonder if this introduces some level of bias, even if the hospitalist did not know the patients were on oral vancomycin, were they aware that a study was going on? #IDJClub |
| ID Journal Club @IDJClub RT @TMcCarty2010: @BradCutrellMD @IDJClub Would you say there's an argument for using fidaxomicin instead since it seems to be narrower spectrum and similarly has data to suggest less risk of relapse in use of treatment? #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @SAIRABT @TMcCarty2010 @IDJClub and how much inappropriate testing does it take to justify a policy like this??? #IDJClub |
| ID Journal Club @IDJClub @infecto79 @ASP_MirandaS Of course #IDJClub |
| Obi Nnedu, MD @onnnedu @NNolanMD Small sample size. Unsure if conclusions can be made regarding VRE acquisition #IDJClub |
| Joshua Torrance @JoshuaRTorrance @IDJClub The amount of discrepancies in antibiotic use between groups is disappointing. Makes it hard to try and tease out if 1° endpoint could be driven by antibiotic-associated diarrhea. Guess we'll have to wait for a RCT 😢 #IDJClub |
 | Saira Butt @SAIRABT @IDJClub @Boghuma Just 24 hr period was enough? #idjclub |
| ID Journal Club @IDJClub @Boghuma Any changes in the methodology besides N? DX? And follow up? #IDJClub |
| Veronica Zafonte @VBZafonte @IDJClub I would have been interested to know if the investigators followed any infection control strategies: rate of observed hand hygiene, terminal cleaning of rooms, etc and if the positive cases were attributed only to systemic antibiotic therapy #IDJClub |
| Darcy Wooten she/her @Darcy_ID_doc @Cortes_Penfield @IDJClub Or maybe if an ID physician made the determination of true infection vs a non specialist #idjclub |
| Brad Cutrell, MD, FIDSA @BradCutrellMD @TMcCarty2010 @IDJClub That is what has been done in high risk HSCT patients https://t.co/W8GgI53s5n #IDJClub |
| Sonali Advani MD, MPH, FIDSA @Sonali_Advani @GermHunterMD @SAIRABT @TMcCarty2010 @IDJClub I know of a few hospitals that have this policy, and interestingly have alarmingly low rates of C difficile. In these cases, we have looked at how much empiric treatment is done (when physicians can't test) #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @GermHunterMD @SAIRABT @IDJClub I feel like CDiff testing is one of those things that's too easy to accomplish with an exceptionally low threshold to do that a relatively straightforward intervention like this has a high yield. #IDJClub |
| ID Journal Club @IDJClub RT @BradCutrellMD: @TMcCarty2010 @IDJClub That is what has been done in high risk HSCT patients https://t.co/W8GgI53s5n #IDJClub |
| Saira Butt @SAIRABT @GermHunterMD @TMcCarty2010 @IDJClub Of course testing has its limitations but this policy is bit shady #IDJClub |
| ID Journal Club @IDJClub @Sonali_Advani @GermHunterMD @SAIRABT @TMcCarty2010 Time to gather the data? #IDJClub |
| Jeff Pearson @jeffpears0n @IDJClub Not really all that fascinated with the cost impact - just 1 C.diff in the no ppx arm would outweigh the costs of daily oral vanco. And VRE colonization seems like they'd need much longer follow-up than 5 days, especially since average duration was 12 days on therapy #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @TMcCarty2010 @SAIRABT @IDJClub Most hospitals I've worked just reject it if the 💩 is formed. That ought to be enough I would think #IDJClub |
| ID Journal Club @IDJClub @Darcy_ID_doc @mmPharmD @Cortes_Penfield The big question the chicken 🐔 vs 🥚 #IDJClub |
| Jeff Pearson @jeffpears0n @IDJClub But still interesting for sure, and a great effort by the study team to look at different aspects of oral vanco ppx #IDJClub |
 | Monica Mahoney @mmPharmD @IDJClub Buried in the 2018 IDSA guidelines, they do say that daily vanco may be an option for CDI ppx ( in pts on broad spectrum and & h/o CDI) #IDJclub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @GermHunterMD @SAIRABT @IDJClub We do that, plus prompt reconsideration of ordering if concurrent laxatives are ordered. #IDJClub |
| ID Journal Club @IDJClub @SandraRajme Do you think these population at higher risk @AST_IDCOP #IDJClub |
| Sonali Advani MD, MPH, FIDSA @Sonali_Advani @Cortes_Penfield @IDJClub @mmPharmD @Darcy_ID_doc Agree completely, people always find a workaround, especially with outcome metrics #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @Darcy_ID_doc @mmPharmD @Cortes_Penfield @IDJClub I think you can/should assume all hospitalized patients are colonized #IDJClub |
| ID Journal Club @IDJClub RT @jeffpears0n: @IDJClub Not really all that fascinated with the cost impact - just 1 C.diff in the no ppx arm would outweigh the costs of daily oral vanco. And VRE colonization seems like they'd need much longer follow-up than 5 days, especially since average duration was 12 days on therapy #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @BradCutrellMD @IDJClub Interesting, especially as it's combined the the worst of the worst antibiotics for CDiff (quinolones) #IDJClub |
| Monica Mahoney @mmPharmD @IDJClub Also, do you know how pissed I am? Spent hours putting together a similar table for an article. Happy to see the same studies here! #validation #idjclub |
| Ilan Schwartz MD PhD @GermHunterMD @Cortes_Penfield @mmPharmD @Darcy_ID_doc @IDJClub Is this a thing?!?!?! #IDJClub |
| Saira Butt @SAIRABT @TMcCarty2010 @GermHunterMD @IDJClub Yep we do that as well, no testing on formed stool and pts on laxative #idjclub |
| ID Journal Club @IDJClub @mmPharmD Missed that one @IDSAInfo what Grade do they give it #IDJClub |
| Michael Angarone @mangarone23 @IDJClub @SandraRajme @AST_IDCOP I worry they are more likely to have recurrence of CDI after first episode #IDJClub |
| Darcy Wooten she/her @Darcy_ID_doc @Cortes_Penfield @mmPharmD @IDJClub Definitely wouldn’t do this routinely for clinical care...but wonder if it would have helped in the study #idjclub |
| Ilan Schwartz MD PhD @GermHunterMD @mmPharmD @IDJClub just once daily? #IDJClub |
 | Ahmad Taqi @Ahmad_Taqi RT @IDJClub: Welcome to our December #IDJClub! Hope everyone had a thankful and fulfilling Thanksgiving. Tonight’s moderator @docwoc71 here & discussing the following article 👇Please use #IDJclub to help us keep track of the conversations. Let’s start with introductions! Who’s joining in? https://t.co/EFTKBHQCvJ |
| Monica Mahoney @mmPharmD @BradCutrellMD @TMcCarty2010 @IDJClub Was going to link this study 😁 #idjclub |
| Michael Angarone @mangarone23 @GermHunterMD @Cortes_Penfield @mmPharmD @Darcy_ID_doc @IDJClub Yes it is and it is gaming the system #IDJClub |
| ID Journal Club @IDJClub @SAIRABT @TMcCarty2010 @GermHunterMD Specially those liver pts on lactulose #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @IDJClub @SAIRABT @GermHunterMD Which is a hard balance to strike too, though. Sick liver patients getting frequent antibiotics. They're CDiff risk isn't low, hard not to worry about it with changes in clinical status. #IDJClub |
| ID Journal Club @IDJClub @mangarone23 @SandraRajme @AST_IDCOP They say about 30-47% of recurrence after 1st episode #IDJClub |
| ID Journal Club @IDJClub @JoshuaRTorrance It does represent our practice. We have not been able to standardize it #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @ClancyNeil @sebpoule @BradCutrellMD @IDJClub I think there has to be some cost effectiveness threshold, can't get caught up paying too much of an increased cost for small/marginal improvements. #IDJClub |
| Monica Mahoney @mmPharmD @BradCutrellMD @IDJClub Playing catchup here. Has anyone brought up what is the ideal timeframe for follow up for a CDI relapse/prevention study? 30 days? 90 days? Longer? #IDJClub |
| Michael Angarone @mangarone23 @IDJClub @SandraRajme @AST_IDCOP That is why I target these immune suppressed for OVP while on antibiotics #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @mmPharmD @BradCutrellMD @IDJClub This reminds me of the DANCE trial discussion... but the opposite. There, 90 days was too long for "relapse" of cellulitis. Here, 30 days way too short for CDI! #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @mmPharmD @BradCutrellMD @IDJClub Is the nature of microbiome alterations with antibiotics understood well enough to guide this? #IDJClub |
| Michael Angarone @mangarone23 @TMcCarty2010 @IDJClub @SAIRABT @GermHunterMD But they are often on Riga I’m in. Doesn’t these treat C diff? 😂 #IDJClub |
| ID Journal Club @IDJClub RT @TMcCarty2010: @IDJClub @SAIRABT @GermHunterMD Which is a hard balance to strike too, though. Sick liver patients getting frequent antibiotics. They're CDiff risk isn't low, hard not to worry about it with changes in clinical status. #IDJClub |
| Brad Cutrell, MD, FIDSA @BradCutrellMD @mmPharmD @IDJClub In the large VA study looking at RCT for treatment of recurrent CDI, they are looking at a 90 day recurrence period (although initially was designed to look at 8 weeks). 30 days is probably a bit short. #IDJClub |
| ID Journal Club @IDJClub @ClancyNeil @Cortes_Penfield @mmPharmD @Darcy_ID_doc Very true my friend #IDJClub |
| ID Journal Club @IDJClub RT @TMcCarty2010: @ClancyNeil @sebpoule @BradCutrellMD @IDJClub I think there has to be some cost effectiveness threshold, can't get caught up paying too much of an increased cost for small/marginal improvements. #IDJClub |
| ID Journal Club @IDJClub RT @GermHunterMD: @mmPharmD @BradCutrellMD @IDJClub This reminds me of the DANCE trial discussion... but the opposite. There, 90 days was too long for "relapse" of cellulitis. Here, 30 days way too short for CDI! #IDJClub |
| ID Journal Club @IDJClub @GermHunterMD @mmPharmD @BradCutrellMD Deja vu #IDJClub |
| Michael Angarone @mangarone23 @Darcy_ID_doc @IDJClub @SandraRajme @AST_IDCOP There is data and this is what we do, sometimes #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD I think the answer is #doxycycline (whatever the question) Low risk of CDI May be protective against CDI #IDJClub |
| ID Journal Club @IDJClub @TMcCarty2010 @mmPharmD @BradCutrellMD Studies ongoing but dysbiosis and microbiome are difficult to predict #IDJClub |
| ID Journal Club @IDJClub RT @BradCutrellMD: @mmPharmD @IDJClub In the large VA study looking at RCT for treatment of recurrent CDI, they are looking at a 90 day recurrence period (although initially was designed to look at 8 weeks). 30 days is probably a bit short. #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @mangarone23 @Darcy_ID_doc @IDJClub @SandraRajme @AST_IDCOP Do you think this is because of higher likelihood of further/broader ABx exposure, or a function of host immune system? #IDJClub |
 | Nico Cortes-Penfield MD FACP 🦴💊 @Cortes_Penfield Me to the fellows when they ask we we do anything in ID: #IDJClub |
| Michael Angarone @mangarone23 @GermHunterMD @Darcy_ID_doc @IDJClub @SandraRajme @AST_IDCOP I think both. They recur because of constant assault from antibiotics, but they have poor immune response increasing likelihood of recurrence #IDJClub |
| Monica Mahoney @mmPharmD @GermHunterMD @IDJClub Page 35. #IDJClub #Savant #PartyTricks https://t.co/1WpMpwuT7U |
| ID Journal Club @IDJClub Table 3: Summarized the efficacy en-points No patients were diagnosed with HCFO-CDI in the OVP group compared with 6 (12%) in the no-prophylaxis group (P = .03) Authors suggest that oral vancomycin can prevent HCFO-CDI in targeted patients. Do you agree? #IDJClub https://t.co/Rxucq8QH5D |
| Veronica Zafonte @VBZafonte @IDJClub Wondering the amount of patients on combination antibiotic therapy (I would imagine most of them for the first few days), and if that had any role #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @ClancyNeil @sebpoule @BradCutrellMD @IDJClub It's the right conversation to have though, and the problem with so much of what we do. Small benefits for a population balanced against a large benefit for an individual for a high cost. We're working in a system with limitations, so that has to be considered. #IDJClub |
| ID Journal Club @IDJClub @mangarone23 @GermHunterMD @Darcy_ID_doc @SandraRajme @AST_IDCOP And no chance of recovery for intestine microbiome #IDJClub |
| Jeff Pearson @jeffpears0n @GermHunterMD @mmPharmD @IDJClub Yes, once daily! Buried on page 35... #IDJClub https://t.co/iT6YQMUhiZ |
| Joshua Torrance @JoshuaRTorrance RT @IDJClub: Table 3: Table 3: Summarized the efficacy en-points No patients were diagnosed with HCFO-CDI in the OVP group compared with 6 (12%) in the no-prophylaxis group (P = .03) Authors suggest that oral vancomycin can prevent HCFO-CDI in targeted patients. Do you agree? #IDJClub https://t.co/Rxucq8QH5D |
 | Kellee Oller MD FACP @kelleeoller RT @IDJClub: Welcome to our December #IDJClub! Hope everyone had a thankful and fulfilling Thanksgiving. Tonight’s moderator @docwoc71 here & discussing the following article 👇Please use #IDJclub to help us keep track of the conversations. Let’s start with introductions! Who’s joining in? https://t.co/EFTKBHQCvJ |
| Michael Angarone @mangarone23 @IDJClub I think these results are the major problem with a small study like this. Hard to make large decisions based on this. #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @IDJClub Much like the Dapto-Ceftaroline MRSA bacteremia study that had zero deaths, always a bit of skepticism when an arm has zero patients reaching the primary end point. It's a good prompt for a larger study, not practice changing in and of itself. #IDJClub |
| ID Journal Club @IDJClub Thoughts on table 3 and results #IDJClub |
| Darcy Wooten she/her @Darcy_ID_doc @IDJClub Too many limitations to make these conclusions as has been pointed out #idjclub |
| Michael Angarone @mangarone23 @TMcCarty2010 @IDJClub Agree #IDJClub |
| ID Journal Club @IDJClub @TMcCarty2010 Handpicked? #IDJClub |
| Darcy Wooten she/her @Darcy_ID_doc @IDJClub Challenges with the diagnosis, short follow up, small numbers #idjclub |
| ID Journal Club @IDJClub @Darcy_ID_doc Small study lots of inference and suppositions #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @Darcy_ID_doc @IDJClub This 2x2 cross table has such low numbers its hard to make any definitive conclusion. But it is encouraging and should support rationale / push for a large RCT #IDJClub |
| ID Journal Club @IDJClub RT @GermHunterMD: @Darcy_ID_doc @IDJClub This 2x2 cross table has such low numbers its hard to make any definitive conclusion. But it is encouraging and should support rationale / push for a large RCT #IDJClub |
| Darcy Wooten she/her @Darcy_ID_doc @IDJClub Promising but looking forward to more data before changing practice #idjclub |
| Michael Angarone @mangarone23 @IDJClub Definitely hypothesis generating and require a larger number of patients #IDJClub |
| Nico Cortes-Penfield MD FACP 🦴💊 @Cortes_Penfield @IDJClub My take on the study boils down to “This is the best study on the topic to date. It is also critically flawed and we basically can’t draw meaningful conclusions from it.” Which honestly is how I feel about a lot of the best data in ID. #IDJClub |
| ID Journal Club @IDJClub @GermHunterMD @Darcy_ID_doc Small study HuGe limitation #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @mangarone23 @IDJClub and supports what a lot of people already doing... though would really like to see longer FU and obviously larger numbers #IDJClub |
| ID Journal Club @IDJClub RT @Cortes_Penfield: @IDJClub My take on the study boils down to “This is the best study on the topic to date. It is also critically flawed and we basically can’t draw meaningful conclusions from it.” Which honestly is how I feel about a lot of the best data in ID. #IDJClub |
| ID Journal Club @IDJClub RT @GermHunterMD: @mangarone23 @IDJClub and supports what a lot of people already doing... though would really like to see longer FU and obviously larger numbers #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @Cortes_Penfield @IDJClub This about says it all.... #IDJClub |
| Monica Mahoney @mmPharmD @TMcCarty2010 @IDJClub Looking at the table summarizing the other OVP studies ... a lot suspiciously had "0" events in the ppx group... #IDJClub |
| Michael Angarone @mangarone23 @mmPharmD @TMcCarty2010 @IDJClub Makes me wonder if this is the best practice or problem with study design #IDJClub |
 | Talia H. Swartz @taliaswartz RT @GermHunterMD: I think the answer is #doxycycline (whatever the question) Low risk of CDI May be protective against CDI #IDJClub |
| ID Journal Club @IDJClub @mangarone23 @mmPharmD @TMcCarty2010 Problem with atudy design: number, defintions big limitations #IDJClub |
 | Dr Khalid, PharmD @KhalidBinHamid @IDJClub The CDI prevalence in Asian countries is hell under diagnosed specially in Malaysia, i couldn't peruse my research on CDI as the patients diagnosed with CDI in one of the biggest tertiary care hospital was less than 10 per year which is hard to believe #IDJClub |
| ID Journal Club @IDJClub @KhalidBinHamid Interesting why do think that is 🧐 #IDJClub |
| Nico Cortes-Penfield MD FACP 🦴💊 @Cortes_Penfield RT @GermHunterMD: We hope to regularly 🖊 letters to editors based on (& on behalf of) #IDJClub chats. This was a 1st effort, spearheaded by the #SHEAJC crew after our respective discussions re DANCE 💃. Thanks to participants of both JCs and @Sonali_Advani for taking the lead |
| Jordan Chiasson @chiassonIDpharm @IDJClub Seeing the 2X2 table really makes me wish they would've been more dosing arms (BID and daily), to help at least target a specific dose if a bigger RCT is done #IDJClub |
| Michael Angarone @mangarone23 @Cortes_Penfield @IDJClub Wonder how we can generate better ID studies? We don’t have the numbers like cardiology or the optimism of HIV research #IDJClub |
| ID Journal Club @IDJClub Poll so far 62% with No #IDJClub |
| Veronica Zafonte @VBZafonte @IDJClub There are so many factors that can go into a HCFO-CDI infection: hand hygiene, properly cleaning/disposing of equipment, antibiotics, PPIs, ..making sure laxatives are off before testing 😏. I don't think vanco PO ppx is the only answer as much as we want it to be #IDJClub |
| ID Journal Club @IDJClub Yes it is a point brought up at the editorial #IDJClub |
 | 🗽Dr Mahalia D🗽 @DrMahaliaD @IDJClub Promising study, but too many flaws to make any practice-changing conclusions. Need a RCT/ larger study. #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @ASP_MirandaS @sebpoule @IDJClub @Darcy_ID_doc Yeah I agree, what we need is not another study of 130 participants! #IDJClub |
| Julio C. Zuniga-Moya @JulioCZuniga1 RT @IDJClub: This is Laila Woc @DocWoc71 tonight's moderator from @bcmhouston and from the Republic of Texas- No COIs #IDJClub |
 | Jack Kiley MD @jackattackiley RT @IDJClub: Its a 🔥🔥🔥 debate in healthcare-assoc infections: Does oral vancomycin prevent #CDiff infections in 🏥 patients receiving systemic antibiotics? Does this study👇 put the issue to 🛌? Join #IDJClub Mon Dec 2 @ 7pmEST to discuss! 🎩tip: @Darcy_ID_doc https://t.co/kpaBuRh0CD https://t.co/7G7Rf92zQH |
| ID Journal Club @IDJClub @DrMahaliaD Totally agree #IDJClub |
| Joshua Torrance @JoshuaRTorrance @IDJClub #IDJClub |
| Michael Angarone @mangarone23 @Boghuma @IDJClub @GermHunterMD @Darcy_ID_doc This study and the other retrospective data would make me more comfortable to give BID OVP in this situation #IDJClub |
| Monica Mahoney @mmPharmD @jeffpears0n @IDJClub Am I tipping my hand here that I didnt read ... did they specify what vanco product was used? Generic capsules, compounded IV as PO solution, or FDA approved oral suspension? 😉 The middle is pennies. The other two ... are way cheaper than CDI as you mentioned. #IDJClub |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 @Boghuma @IDJClub A phrase along those lines is part of almost every talk I give to med students and residents. #IDJClub |
| Jeff Pearson @jeffpears0n @GermHunterMD @mangarone23 @IDJClub Exactly. I likely will never push back against oral vanco ppx if it is ordered, but larger numbers are still needed to make it standard of practice at our institution up front #IDJClub |
| Joshua Torrance @JoshuaRTorrance @GermHunterMD @ASP_MirandaS @sebpoule @IDJClub @Darcy_ID_doc But a few more of those and we have ourselves a meta-analysis! 😅 #IDJClub |
| ID Journal Club @IDJClub @Boghuma In the poll@it was maybe #IDJClub |
 | Neil Clancy @ClancyNeil @IDJClub So I guess I agree #IDJclub |
| Michael Angarone @mangarone23 @jeffpears0n @GermHunterMD @IDJClub Wonder if this should be a practice that is patient and situation dependent. Not a “rule” for all patients #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @sigal_md @Boghuma @IDJClub @Darcy_ID_doc yes you are right, these are the patients we were not going to ppx anyway #IDJClub |
| Obi Nnedu, MD @onnnedu @IDJClub would interesting to see if OVP reduces risk of c diff recurrence in those with recent c diff who require antibiotics or PPI #IDJClub |
| ID Journal Club @IDJClub @onnnedu Another twist another trial #IDJClub |
| Michael Angarone @mangarone23 @sigal_md @Boghuma @IDJClub @GermHunterMD @Darcy_ID_doc My answer is no #IDJClub |
| Jeff Pearson @jeffpears0n @mmPharmD @IDJClub Yep. I see no reason why Cutis Pharma wouldn't want to sponsor a larger RCT on C.diff prophylaxis for this exact reason - it would create an enormous new revenue stream for them #IDJClub |
| Neil Clancy @ClancyNeil @IDJClub Using vanco in this setting is like the Lewis Powell definition of pornography—-hard to define, but you know it when you see it. #IDJClub |
| ID Journal Club @IDJClub More on this topic in the editorial Garey KW Perils, pitfalls, & promise of primary prophylaxis for Clostridioides difficile infection https://t.co/Ew1Z9yX8Yr The study provides a good starting point for future trials to further optimize Rx to prevent CDI #IDJClub |
| ID Journal Club @IDJClub Winding down thumbs are sore #IDJClub |
| ID Journal Club @IDJClub RT @ClancyNeil: @IDJClub Using vanco in this setting is like the Lewis Powell definition of pornography—-hard to define, but you know it when you see it. #IDJClub |
| ID Journal Club @IDJClub Well that's a wrap for our 3rd #IDJClub Wishing you & your loved ones a Happy Holidays & blessed #NewYear2020 from all us-your twitter friends @GermHunterMD @Cortes_Penfield @TMcCarty2010 @DocWoc71 Please keep the suggestions coming to our DM or tweet See u on Jan 6 2020 9pmEST |
| Nico Cortes-Penfield MD FACP 🦴💊 @Cortes_Penfield RT @IDJClub: Well that's a wrap for our 3rd #IDJClub Wishing you & your loved ones a Happy Holidays & blessed #NewYear2020 from all us-your twitter friends @GermHunterMD @Cortes_Penfield @TMcCarty2010 @DocWoc71 Please keep the suggestions coming to our DM or tweet See u on Jan 6 2020 9pmEST |
| Todd McCarty 💊🐉👨⚕️ @TMcCarty2010 RT @IDJClub: Well that's a wrap for our 3rd #IDJClub Wishing you & your loved ones a Happy Holidays & blessed #NewYear2020 from all us-your twitter friends @GermHunterMD @Cortes_Penfield @TMcCarty2010 @DocWoc71 Please keep the suggestions coming to our DM or tweet See u on Jan 6 2020 9pmEST |
| Michael Angarone @mangarone23 @jeffpears0n @mmPharmD @IDJClub Would be interesting to compare OVP to OFP and look at microbiome and VRE rates. #IDJClub |
| Talia H. Swartz @taliaswartz @IDJClub @GermHunterMD @Cortes_Penfield @TMcCarty2010 @DocWoc71 Amazing job! Sorry I came late. Happy holidays #IDTwitter #IDJClub |
| ID Journal Club @IDJClub @mangarone23 @jeffpears0n @mmPharmD So far we have 3 studies to do 😍 #IDJClub |
| Jeff Pearson @jeffpears0n @ASP_MirandaS @sebpoule @IDJClub @GermHunterMD @Darcy_ID_doc How do we enlist Cutis Pharma to see if they'd be interested in funding a larger study? Switching Firvanq from treatment-based use to treatment and prophylaxis would be enormous for their revenue streams I'd think... #IDJClub |
| Joshua Torrance @JoshuaRTorrance @IDJClub @GermHunterMD @Cortes_Penfield @TMcCarty2010 @DocWoc71 Thanks for all the work to put on another great #IDJClub - looking forward to a full year of them! |
| Darcy Wooten she/her @Darcy_ID_doc @IDJClub @GermHunterMD @Cortes_Penfield @TMcCarty2010 @DocWoc71 Thanks! Great discussion! I learned a lot! #idjclub |
 | Vinod Babu Murakonda 🇮🇳 @MurakondaVinod RT @IDJClub: To get this 🔥 up Will start with a poll question: To get this 🔥 up Will start with a poll question: who routinely uses oral vanco ppx in patients on broad-spectrum antibiotic ? 🧐 Please comment on the maybe #IDJClub |
| Julio C. Zuniga-Moya @JulioCZuniga1 RT @IDJClub: Well that's a wrap for our 3rd #IDJClub Wishing you & your loved ones a Happy Holidays & blessed #NewYear2020 from all us-your twitter friends @GermHunterMD @Cortes_Penfield @TMcCarty2010 @DocWoc71 Please keep the suggestions coming to our DM or tweet See u on Jan 6 2020 9pmEST |
| Michael Angarone @mangarone23 @IDJClub @GermHunterMD @Cortes_Penfield @TMcCarty2010 @DocWoc71 Excellent #IDJClub great discussion. Thanks for moderating |
| Dr Khalid, PharmD @KhalidBinHamid @IDJClub Patients with CDI symptoms in hospital setting are prescribed with Metronidazole directly without further investigation and a study suggests 90% of mild and 76% of severe CDI patients respond to metronidazole which will lead to underdiagnosis of CDI #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD A meta-analysis trying to answer a clinical question with data gleamed from flawed studies #idjclub #epitwitter #AcademicChatter https://t.co/9XbRDq6Oy0 |
 | Laila Woc-Colburn, MD @DocWoc71 RT @JoshuaRTorrance: @IDJClub @GermHunterMD @Cortes_Penfield @TMcCarty2010 @DocWoc71 Thanks for all the work to put on another great #IDJClub - looking forward to a full year of them! |
| Laila Woc-Colburn, MD @DocWoc71 @ClancyNeil @IDJClub @GermHunterMD @Cortes_Penfield @TMcCarty2010 Jan 6th next one #IDJClub |
| Jeff Pearson @jeffpears0n @IDJClub @GermHunterMD @Cortes_Penfield @TMcCarty2010 @DocWoc71 Thanks for hosting @DocWoc71, another great discussion! #IDJClub |
| Laila Woc-Colburn, MD @DocWoc71 @Darcy_ID_doc @IDJClub @GermHunterMD @Cortes_Penfield @TMcCarty2010 Thank unfor the suggestion #IDJClub |
| Laila Woc-Colburn, MD @DocWoc71 RT @GermHunterMD: A meta-analysis trying to answer a clinical question with data gleamed from flawed studies #idjclub #epitwitter #AcademicChatter https://t.co/9XbRDq6Oy0 |
 | Sébastien Poulin @sebpoule @GermHunterMD @ASP_MirandaS @IDJClub @Darcy_ID_doc https://t.co/54EvpWW0Og #IDJClub |
| Ilan Schwartz MD PhD @GermHunterMD @JoshuaRTorrance @ASP_MirandaS @sebpoule @IDJClub @Darcy_ID_doc Here's what I think of that https://t.co/1kGA07AlSW |
| 🗽Dr Mahalia D🗽 @DrMahaliaD @IDJClub @GermHunterMD @Cortes_Penfield @TMcCarty2010 @DocWoc71 Great discussion. Thank you for moderating. Happy holidays! #IDJClub |
| Julio C. Zuniga-Moya @JulioCZuniga1 RT @GermHunterMD: A meta-analysis trying to answer a clinical question with data gleamed from flawed studies #idjclub #epitwitter #AcademicChatter https://t.co/9XbRDq6Oy0 |
| Jeff Pearson @jeffpears0n @IDJClub I'm physically unable to use my phone for these #IDJClub posts, it's too fast-paced. Laptop for Tweets with phone for keeping up has been my go-to. Kudos to you for getting through it all on your phone! |
| Laila Woc-Colburn, MD @DocWoc71 @ClancyNeil @IDJClub @GermHunterMD @Cortes_Penfield @TMcCarty2010 You got it! #IDJClub |
| Sébastien Poulin @sebpoule RT @GermHunterMD: A meta-analysis trying to answer a clinical question with data gleamed from flawed studies #idjclub #epitwitter #AcademicChatter https://t.co/9XbRDq6Oy0 |
| Monica Mahoney @mmPharmD @jeffpears0n @ASP_MirandaS @sebpoule @IDJClub @GermHunterMD @Darcy_ID_doc Would it? Ppl already doing ppx. Look at all retro studies. How many million$ needed for this type of study? How best to design? How many issues pointed out today? What is the market capture of vanco caps, using IV, or firvanq? Would it really help bottom line? #IDJClub |
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