Issue: June 2019
May 09, 2019
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Prophylactic oral vancomycin does not consistently reduce risk for CDI relapse

Issue: June 2019
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Prophylactic oral vancomycin does not consistently reduce the risk for Clostridioides difficile infection, or CDI, relapse in patients receiving systemic antibiotics during hospitalization, researchers found.

Perspective from Aaron E. Glatt, MD

Each year in the United States, there are more than 450,000 cases of CDI resulting in nearly 30,000 deaths. Moreover, the rate of CDI relapse is approximately 25%, underscoring a need to investigate “practical” ways to reduce recurrent infection, Daniel A. Caroff, MD, MPH, a postdoctoral fellow at Harvard Pilgrim Health Care and associate physician at Brigham and Women’s Hospital in Boston, and colleagues wrote.

“It has become common to see oral vancomycin used as prophylaxis, usually for patients with a history of C. difficile infection who require antibiotics for other reasons,” Caroff told Infectious Disease News. “We used a large population and robust statistical methods to account for many confounding factors but did not find a consistent benefit.”

Caroff and colleagues conducted a retrospective cohort study comparing CDI relapse rates in patients who started oral vancomycin at the same time as systemic antibiotics — the exposed group (n = 193) — with patients who did not (n = 567). They included adult patients with a history of CDI who received systemic antibiotics and were hospitalized at Brigham and Women’s Hospital or Massachusetts General Hospital between January 2009 and June 2015. Testing by toxin or nucleic acid at 90 days confirmed a CDI relapse.

Within 90 days, 9.8% of patients in the exposed group experienced a CDI relapse compared with 9.4% in the unexposed group (unadjusted OR = 1.06; 95% CI, 0.6-1.81; adjusted OR = 0.63; 95% CI, 0.35-1.14).

However, the findings did demonstrate a lower frequency of CDI relapse at 90 days among exposed patients with only one prior episode of CDI (OR = 0.42; 95% CI, 0.19-0.93) compared with exposed patients with more than one prior CDI episode (OR = 1.19; 95% CI, 0.42-3.33), showing the intervention may be beneficial for patients with only one prior CDI episode.

“The take-home message is that using oral vancomycin to prevent C. difficile relapse may not be as effective as previously thought,” Caroff said. “All available studies on this topic, including ours, have been retrospective. We need a prospective study to determine the true effect.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.