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Clin Infect Dis. 2018 Sep 26. doi: 10.1093/cid/ciy822. [Epub ahead of print]

Oral vancomycin prophylaxis is highly effective in preventing Clostridium difficile infection in allogeneic hematopoietic cell transplant recipients.

Author information

1
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
2
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
3
Department of Healthcare Epidemiology, Infection Prevention and Control, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
4
Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Abstract

Background:

Clostridiumdifficile infection (CDI) is a leading cause of infectious complications in allogeneic hematopoietic cell transplant recipients (alloHCT). We sought to evaluate whether prophylactic oral vancomycin reduces the incidence of CDI in alloHCT recipients.

Methods:

We conducted a retrospective cohort study to examine the effectiveness of CDI prophylaxis with oral vancomycin compared to no prophylaxis in 145 consecutive adult alloHCT recipients at the University of Pennsylvania between April 2015 and November 2016. Patients received oral vancomycin 125 mg twice daily starting on admission and continued until discharge. The primary outcome of interest was the association between oral vancomycin prophylaxis and CDI diagnosis. Secondary outcomes included graft-versus-host-disease (GVHD) and relapse.

Results:

There were no cases of CDI in patients that received prophylaxis 0/90 (0%) whereas 11/55 (20%) patients who did not receive prophylaxis developed CDI (P<0.001). Oral vancomycin prophylaxis was not associated with a higher risk of acute grade 2 - 4 [subhazard ratio (sHR) 1.59; 95% confidence interval (CI), 0.88 - 2.89; P=0.12], grade 3 - 4 (sHR 0.65; 95% CI, 0.25 - 1.66; P=0.36), or grade 2 - 4 gastrointestinal GVHD (sHR 1.95; 95% CI, 0.93 - 4.07; P=0.08) at day 180 post-transplant. No associations between oral vancomycin and relapse or survival were observed.

PMID:
30256954
DOI:
10.1093/cid/ciy822

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