Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-28T03:57:48.405Z Has data issue: false hasContentIssue false
  • English
  • Français

Oral vancomycin prophylaxis during systemic antibiotic exposure to prevent Clostridiodes difficile infection relapses

Published online by Cambridge University Press:  29 April 2019

Daniel A. Caroff ,
John T. Menchaca ,
Zilu Zhang ,
Chanu Rhee ,
Michael S. Calderwood ,
David W. Kubiak ,
Deborah S. Yokoe  and
Michael Klompas
Daniel A. Caroff*
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts Department of Infectious Disease, Lahey Hospital and Medical Center, Burlington, Massachusetts
John T. Menchaca
Affiliation:
University of Texas Southwestern Medical Center, Dallas, Texas
Zilu Zhang
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
Chanu Rhee
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Michael S. Calderwood
Affiliation:
Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
David W. Kubiak
Affiliation:
Department of Pharmacy, Brigham and Women’s Hospital, Boston Massachusetts
Deborah S. Yokoe
Affiliation:
Department of Medicine, University of California, San Francisco Medical Center, San Francisco, California.
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
*
Author for correspondence: Daniel A. Caroff, E-mail: dcaroff@gmail.com; Michael Klompas, E-mail: mklompas@partners.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine whether oral vancomycin prophylaxis accompanying systemic antibiotics reduces the risk of relapse in patients with history of Clostridioides difficile infection (CDI).

Design:

Retrospective cohort study.

Patients:

Adult inpatients with a history of CDI who received systemic antibiotics in either of 2 hospitals between January 2009 and June 2015.

Methods:

We compared relapse rates in patients who started oral vancomycin concurrently with systemic antibiotics (exposed group) versus those who did not. We assessed for CDI relapse by toxin or nucleic acid testing at 90 days. We used inverse probability weighting and machine learning to adjust for confounders, to estimate propensity for treatment, and to calculate odds ratios for CDI relapse. We performed secondary analyses limited to toxin-positive relapses, patients with 1 versus >1 prior CDI episodes, and patients who received oral vancomycin on each antibiotic day.

Results:

CDI relapse occurred within 90 days in 19 of 193 exposed patients (9.8%) versus 53 of 567 unexposed patients (9.4%; unadjusted odds ratio [OR], 1.06; 95% confidence interval [CI], 0.60–1.81; adjusted OR, 0.63; 95% CI, 0.35–1.14). CDI relapses at 90 days were less frequent in exposed patients with only 1 prior episode of CDI (OR, 0.42; 95% CI, 0.19–0.93) but not in those with >1 prior episode (OR, 1.19; 95% CI, 0.42–3.33). Our findings were consistent with a lack of benefit of oral vancomycin when restricting results to toxin-positive relapses and to patients who received vancomycin each antibiotic day.

Conclusions:

Prophylactic oral vancomycin was not consistently associated with reduced risk of CDI relapse among hospitalized patients receiving systemic antibiotics. However, patients with only 1 prior CDI episode may benefit.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 6 , June 2019 , pp. 662 - 667
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.CrossRefGoogle ScholarPubMed
Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.CrossRefGoogle ScholarPubMed
Cornely, OA, Crook, DW, Esposito, R, et al. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis 2012;12:281–289.CrossRefGoogle ScholarPubMed
Louie, TJ, Miller, MA, Mullane, KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011;364:422–431.CrossRefGoogle ScholarPubMed
Rodrigues, R, Barber, GE, Ananthakrishnan, AN. A Comprehensive study of costs associated with recurrent Clostridium difficile infection. Infect Control Hosp Epidemiol 2017;38:196–202.CrossRefGoogle ScholarPubMed
Van Hise, NW, Bryant, AM, Hennessey, EK, Crannage, AJ, Khoury, JA, Manian, FA. Efficacy of oral vancomycin in preventing recurrent Clostridium difficile infection in patients treated with systemic antimicrobial agents. Clin Infect Dis 2016;63:651–653.CrossRefGoogle ScholarPubMed
Carignan, A, Poulin, S, Martin, P, et al. Efficacy of secondary prophylaxis with vancomycin for preventing recurrent Clostridium difficile infections. Am J Gastroenterol 2016;111:1834–1840.CrossRefGoogle ScholarPubMed
Stevens, V, Dumyati, G, Fine, LS, Fisher, SG, van Wijngaarden, E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis 2011;53:42–48.CrossRefGoogle ScholarPubMed
Nelson, DE, Auerbach, SB, Baltch, AL, et al. Epidemic Clostridium difficile-associated diarrhea: role of second- and third-generation cephalosporins. Infect Control Hosp Epidemiol 1994;15:88–94.CrossRefGoogle ScholarPubMed
Bignardi, GE. Risk factors for Clostridium difficile infection. J Hosp Infect 1998;40:1–15.CrossRefGoogle ScholarPubMed
McFarland, LV, Surawicz, CM, Stamm, WE. Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis 1990;162:678–684.CrossRefGoogle Scholar
Zacharioudakis, IM, Zervou, FN, Pliakos, EE, Ziakas, PD, Mylonakis, E. Colonization with toxinogenic C. difficile upon hospital admission, and risk of infection: a systematic review and meta-analysis. Am J Gastroenterol 2015;110:381–390.CrossRefGoogle ScholarPubMed
Loo, VG, Bourgault, AM, Poirier, L, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med 2011;365:1693–1703.CrossRefGoogle ScholarPubMed
Elixhauser, A, Steiner, C, Harris, DR, Coffey, RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8–27.CrossRefGoogle ScholarPubMed
Brown, KA, Khanafer, N, Daneman, N, Fisman, DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother 2013;57:2326–2332.CrossRefGoogle ScholarPubMed
Pirracchio, R, Petersen, ML, van der Laan, M. Improving propensity score estimators’ robustness to model misspecification using super learner. Am J Epidemiol 2015;181:108–119.CrossRefGoogle ScholarPubMed
Gruber, S, van der Laan, M. tmle: an R package for targeted maximum likelihood estimation. J Stat Softw 2012;51:35.CrossRefGoogle Scholar
Lee, BK, Lessler, J, Stuart, EA. Improving propensity score weighting using machine learning. Stat Med 2010;29:337–346.Google ScholarPubMed
Johnson, S, Homann, SR, Bettin, KM, et al. Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. A randomized, placebo-controlled trial. Ann Intern Med 1992;117:297–302.CrossRefGoogle ScholarPubMed
Polage, CR, Gyorke, CE, Kennedy, MA, et al. Overdiagnosis of Clostridium difficile infection in the molecular test era. JAMA Intern Med 2015;175:1792–1801.CrossRefGoogle ScholarPubMed
Supplementary material: File

Caroff et al. supplementary material

Appendix 1

Download Caroff et al. supplementary material(File)
File 66.2 KB