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Clin Infect Dis. 2019 Sep 27. pii: ciz966. doi: 10.1093/cid/ciz966. [Epub ahead of print]

Effectiveness of Oral Vancomycin for Prevention of Healthcare Facility-Onset Clostridioides difficile Infection in Targeted Patients During Systemic Antibiotic Exposure.

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Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Science, Buies Creek, North Carolina.
Novant Health Forsyth Medical Center, Winston-Salem, North Carolina.
Novant Health Institute for Safety and Quality, Winston-Salem, North Carolina.
Novant Health Infectious Disease Specialists, Winston-Salem, North Carolina.



Limited retrospective data suggests prophylactic oral vancomycin may prevent Clostridioides difficile infection (CDI). We sought to evaluate the effectiveness of oral vancomycin for the prevention of health care facility-onset CDI (HCFO-CDI) in targeted patients.


We conducted a randomized, prospective, open-label study at Novant Health Forsyth Medical Center in Winston-Salem, North Carolina between October 2018 and April 2019. Included patients were randomized 1:1 to either oral vancomycin (dosed at 125 mg once daily while receiving systemic antibiotics and continued for 5 days post completion of systemic antibiotics [OVP]), or no prophylaxis. The primary endpoint was incidence of HCFO-CDI. Secondary endpoints included incidence of community-onset healthcare facility-associated CDI (CO-HCFA-CDI), incidence of vancomycin-resistant Enterococci (VRE) colonization after receiving OVP, adverse effects and cost of OVP.


A total of 100 patients were evaluated, 50 patients in each arm. Baseline and hospitalization characteristics were similar, except antibiotic exposure. No events of HCFO-CDI were noted in the OVP group compared to 6 (12%) in the no prophylaxis group (p = 0.03). CO-HCFA-CDI was identified in 2 patients who were previously diagnosed with HCFO-CDI. No patients developed new VRE colonization with only 1 patient reporting mild gastrointestinal side effects to OVP. A total of 600 doses of OVP were given during the study, with each patient receiving an average of 12 doses. Total acquisition cost of OVP was $1302, $26.04 per patient.


OVP appears to protect against HCFO-CDI during in-patient stay in targeted patients during systemic antibiotic exposure. Further prospective investigation is warranted.


CDI; Clostridioides difficile; Clostridium difficile infection; healthcare facility-onset; oral vancomycin prophylaxis


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