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Oral Vancomycin Prophylaxis as Secondary Prevention Against Clostridioides difficile Infection in the Hematopoietic Stem Cell Transplant and Hematologic Malignancy Population.
Biol Blood Marrow Transplant. 2019 Jun 27;:
Authors: Morrisette T, Van Matre AG, Miller MA, Mueller SW, Bajrovic V, Abidi MZ, Benamu E, Kaiser JN, Barber GR, Chase S, Tobin J, Fish DN, Gutman JA
Abstract
Clostridioides difficile infection (CDI) is a common complication in the hematopoietic stem cell transplant (HSCT) and hematologic malignancy (HM) population. CDI is associated with increased hospital length of stay, health care and societal costs, morbidity, and mortality. Identifying strategies for secondary prevention of CDI is of extreme importance in the HSCT/HM population. Our primary objective was to evaluate the effectiveness and safety of an oral vancomycin prophylaxis (OVP) protocol for secondary prevention of CDI in HSCT/HM patients. Retrospective cohort of adult autologous/allogeneic HSCTs and non-transplant HMs with first CDI episode receiving concomitant broad-spectrum antibiotics (BSA). Patients were diagnosed and treated for CDI inpatient and/or outpatient, and were divided into two groups based on a pre- vs. post-protocol analysis (OVP group: patients who received planned monotherapy with oral vancomycin 125 mg every six hours for 14 days for first episode of CDI and subsequently received OVP post-treatment versus no OVP (NOVP) group: patients who received planned monotherapy with oral vancomycin 125 mg every six hours for 14 days for initial episode of CDI and subsequently did not receive OVP post-treatment). OVP was defined as vancomycin 125 mg every 12 hours until seven days after BSA discontinuation. The primary endpoint was recurrent CDI (rCDI), defined as symptoms of loose stools/diarrhea with high clinical suspicion for CDI prompting empirical therapy within 60 days of completion of treatment/prophylaxis for initial CDI episode. Incidence of vancomycin-resistant Enterococcus spp. (VRE) infections and 60-day mortality were also compared. Multivariate logistic regression was created from associated variables to identify independent associations with rCDI. 50 patients were included (OVP: 21/50 [42%] vs. NOVP: 29/50 [58%]): mean age 58 years, 60% male, and 86% Caucasian. HSCT was performed in 60% of patients and 76% of CDI cases were diagnosed during hospitalization. Comparing the OVP to NOVP group, rCDI was significantly reduced (1/21 [5%] vs. 10/29 [35%]; p=0.016), with no subsequent increase in VRE infection rates (3/21 [14%] vs. 3/29 [10%]; p=0.686). By multivariable logistic regression, rCDI was inversely associated with OVP (OR 0.14; 95% CI, 0.007-0.994; p=0.049) and directly associated with outpatient CDI diagnosis (OR 8.72; 95% CI, 1.816-49.158; p=0.007). No differences were found in 60-day mortality (OVP: 2/21 [10%] vs. NOVP: 2/29 [7%]; p>0.999) between the two groups. OVP appears effective and safe for secondary prevention of CDI in the HSCT/HM population. Prospective trials are needed to validate the effectiveness of OVP in this vulnerable population to prevent rCDI.
PMID: 31255741 [PubMed - as supplied by publisher]