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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.

Author information

1
Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Science, Buies Creek, North Carolina.
2
Novant Health Forsyth Medical Center, Winston-Salem, North Carolina.
3
Novant Health Institute for Safety and Quality, Winston-Salem, North Carolina.
4
Novant Health Infectious Disease Specialists, Winston-Salem, North Carolina.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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

KEYWORDS:

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

PMID:
31560051
DOI:
10.1093/cid/ciz966

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