This article is more than 5 years old. Information may no longer be current.
Oral vancomycin prevents C. difficile infection in allogeneic HSCT recipients
Click Here to Manage Email Alerts
SAN DIEGO — Oral vancomycin, a standard antibiotic, effectively prevented Clostridium difficile infection in patients undergoing allogeneic hematopoietic stem cell transplantation, according to study results presented at the ASH Annual Meeting and Exposition.
“This is the first study to evaluate this preventative strategy in stem cell transplant recipients and the results are encouraging,” Alex Ganetsky, PharmD, clinical pharmacist in the Blood and Marrow Transplantation Program at Abramson Cancer Center of University of Pennsylvania said, said in a press release. “This may become the standard of care at Penn among patients receiving allogeneic stem cell transplants.”
Oral vancomycin has been used to treat C. difficile infection, a toxin-mediated diarrheal disease that occurs in up to 30% of all allogeneic HSCT recipients. C. difficile can lead to severe inflammation of the bowel and other medical complications that increase hospital stays and treatment costs. Study data have reported the average cost to treat a patient with C. difficile ranges from $8,911 to $30,049, according to the press release.
Ganetsky and colleagues evaluated data from 128 adults undergoing allogeneic HSCT at University of Pennsylvania between April 2015 and July 2016. Of those, 73 patients (median age, 58 years) received 125 mg twice daily oral vancomycin from the day of inpatient admission through discharge. The other 55 patients (median age, 59 years) did not receive oral vancomycin. Incidence of C. difficile from inpatient admission to discharge served as the study’s primary endpoint.
None of the patients who received oral vancomycin daily developed C. difficile during their hospital stay. Eleven (20%) of the patients who did not receive oral vancomycin developed C. difficile during their hospital stay. The median time to C. difficile diagnosis was 8 days (interquartile range, 6-12).
Mean length of stay was 36 days in the prophylaxis arm and 33 days in the control arm.
Cumulative incidence of acute grade 2 through 4 graft-versus-hosts disease (GVHD; HR = 1.66; 95% CI, 0.88-3.14) and acute gastrointestinal grade 2 through grade 4 GVHD (HR = 1.72; 95% CI, 0.8-3.71) did not significantly differ between the arms.
Incidence of relapse (22% vs. 31%) and the proportion of patients alive at last follow-up (81% vs. 62%) was also comparable between the arms.
“This was a retrospective analysis, so we need to follow-up with randomized trials that specifically look at length of stay,” study researcher David Porter, MD, director of Blood and Marrow Transplantation and Jodi Fisher Horowitz professor in leukemia care excellence at Abramson Cancer Center, said in the release. “Finding such a drop-off in C. difficile is enough to push us to continue this line of study.”
no cases of vancomycin-resistant enterococcus bloodstream infections in any of the patients who received vancomycin.
Because C. difficile and its treatment may alter the gut microbiome, longer follow-up will determine if there is any impact on other outcomes, researchers said.
The practice of using oral vancomycin as an infection preventative could expand patients with acute leukemia undergoing other types of treatments, but there remains a potential for antibiotic resistance, Ganetsky said in the release.
“What we want to do is maximize the appropriate use of antibiotics,” Porter said. “With our control group showing a 20% infection rate, that means we’re giving the antibiotics to a lot of other people who would not have otherwise developed C. difficile, but given the risks associated with the condition for these patients, our results demonstrate a potential path to protecting more of them during a very vulnerable period of their recovery.” – by Chuck Gormley
Disclosures: Porter reports employment with Genentech, as well as patents and royalties from Novartis. Ganetsky reports no relevant financial disclosures. Please see the abstract for a list of all other researchers’ relevant financial disclosures.