Pharmacy Times interviewed Vincent Young, MD, PhD, William Henry Fitzbutler professor, Department of Internal Medicine/Infectious Diseases and collegiate professor, Department of Microbiology & Immunology, University of Michigan Medical School, on his work in Clostridioides difficile (C difficile) care and treatment as an infectious disease physician. Young address his participation in Peggy Lillis Foundation's 2024 National C diff Advocacy Summit and takeaways from the event.
Pharmacy Times: What is the focus of your work in C difficile care and treatment as an infectious disease physician?
Key Takeaways
- Interdisciplinary Collaboration: Vincent Young, MD, PhD, emphasizes the importance of teamwork in health care delivery, where pharmacists play a critical role in patient care, particularly in managing Clostridioides difficile infections. This collaborative approach ensures comprehensive and tailored treatment plans.
- Patient-Centered Care: Young highlights the significance of involving patients in health care decisions and the care process. He stresses that effective health care delivery requires a team that includes patients, working together towards optimal outcomes.
- Community-Based Stewardship: Young underscores the feasibility and effectiveness of pharmacy-initiated stewardship programs beyond academic medical centers, emphasizing that such initiatives can enhance patient care in community settings and contribute to better outcomes.
Vincent Young, MD, PhD: So, in my career as an academic infectious disease [ID] physician, I do both clinical care—but the vast majority of my time is spent running an academic research lab, and we study C difficile infection, as well as other health care–associated infections. In particular, [we look at] how they're related to the interaction with the normal microbiota of the gut. So, when it comes to the clinical aspects, we've done translational work, where we've taken large numbers of patients and looked at patient care and seeing if we can detect, for example, transmission of C difficile from one strain from one patient to another in the [intensive care unit (ICU)], and if patients who are colonized with C difficile when they hit the ICU, are they at increased or decreased risk of developing actual overt infection? We've spent a lot of time looking at how the microbiota can interfere with C difficile, [which is] this idea of colonization resistance. So, we've looked at both the basic science of C difficile but also how that relates to our care of actual patients with the infection.
Pharmacy Times: How did your work in C difficile bring you to get connected with the Peggy Lillis Foundation?
Young: The Peggy Lillis Foundation found me because of the research that I had been doing on C difficile. They invited me to the gala, and they honored me for the work that I had done on the basic research of C difficile. But it was quite interesting. My graduate students—in fact 2 of them—I noted during their talks, they had found the Peggy Lillis Foundation, and when they were giving their departmental seminars, they were talking about, ‘Let's talk about how this really affects patients,’ and they actually found Peggy’s story and use that, and that wasn’t something that I fed to them. It was something that they found out. So, I was actually quite intrigued by the fact that 2 of my graduate students were able to find out by doing a clever Google search that this is a place that really does advocate for awareness of C difficile infection.
Pharmacy Times: How do you work with pharmacists in your practice caring for and treating patients with C difficile?
Young: It's really critical that I work with pharmacists. When I am seeing patients, and I see them at our local Ann Arbor VA hospital, I am there with a pharmacist the whole time. So, we start out our rounds by kind of sitting around a table with the ID fellow, any residents or medical students around the team, and the pharmacist, and we basically go over all of the patients that we've seen already, and the new patients that were consulted on that day, and we see much more than C difficile infection. We always have a few cases of C difficile any month that I'm on, [and] the pharmacists are incredibly helpful for many reasons. One is they know the antibiotic history of each individual patient. They've known what infections they've had before, how they've reacted to various antibiotics, they know what kinds of organisms they were infected with, what was their antimicrobial resistance pattern on a given isolate from that exact patient. Say, ‘Well, look, 3 months ago, they had an E coli that was resistant to these particular drugs. So, if we're suspecting an E coli infection our empiric antibiotics are actually modified based on knowing the patient history.
It's incredibly valuable that I work closely all the time with the pharmacists. We go round the hospital together, so after we're done on sit down rounds, it's not like we leave and go see the patients—[pharmacists] come with us, and we actually discuss things as we're walking down the hall and as we're outside the patient's room. [Pharmacists] come in to meet the patients, and we do important things like, for example, we do look to see if their allergies that are listed in their chart are true allergies or not. Does it really limit the antibiotics we can give, or, in some cases, in particular with penicillin allergies, are we able to test these patients and actually give that important class of antimicrobials to them?
Pharmacy Times: What are some takeaways from the panel discussions you participated in at the Peggy Lillis Foundation's 2024 C diff Advocacy Summit?
Young: I think the critical thing that has come from the panels is that the way medicine is now, it really is health care being provided by teams working together—that's the best kind of health care. It's not this lone brilliant physician wandering through the hospital diagnosing and treating everything, because they know everything there is to know about the individual patient, everything there is to know about medicine and all the drugs—it's impossible. I think that this idea of teamwork on a health care system—and that teamwork actually involves the patient critically, I think that's an important thing. For whatever reason, there's this perception that there's this somewhat adversarial relationship [between patients and health care professionals] and the patients have to advocate for themselves because the doctors and the rest of the health care team might not have their best interests in mind. I think perhaps that comes up rarely, but really, if everyone is working together as a team, the patient and all of the health care providers, I think that's when we can provide the best care to our patients, regardless of what the medical problem is specifically.
Pharmacy Times: Any closing thoughts?
Young: I think that it was an important piece that was highlighted when it was shown that this idea of pharmacy-initiated stewardship is something that can take place in the community setting. I've known for my entire time at the University of Michigan that I was always going to run with a pharmacist, and this has been going on for nearly 20 years. But really, this is not something that's just reserved for these tertiary academic medical centers, it is possible to do it in the community setting, and more importantly, it's effective, and it actually helps us provide better care.
So, I think that's a message not just for the pharmacists, but one that the pharmacists can bring to the C suite to say, ‘Look, this is not just something that these other places can do. We can do this here, and this will provide better care for our patients and not cost us more,’ because that's always something that we have to be cognizant of.
