Vancomycin Prophylaxis for Prevention of Clostridium difficile Infection Recurrence in Renal Transplant Patients

Background: Incidence of primary and recurrent Clostridium difficile infection (CDI) is higher in solid-organ transplant recipients than in the average hospitalized patient. Strategies for preventing recurrent CDI are limited. Prophylaxis with oral vancomycin (VPPx) for preventing recurrent CDI may be beneficial, but there is limited evidence supporting its use. Objective: To examine the impact of VPPx (125 mg twice daily) for the prevention of recurrent CDI in renal transplant recipients (RTX) receiving high-risk broad spectrum antibiotics (BSAs). Methods: Adult RTX with history of CDI, hospitalized with receipt of BSAs during a unit-specific CDI outbreak period—January 1, 2012, to December 31, 2015—were divided into 2 matched cohorts: patients who received VPPx concomitantly with BSAs and patients who did not. The primary objective was incidence of CDI recurrence, defined as CDI occurring ≤30 days after receipt of BSAs but ≥48 hours after beginning VPPx. Univariate analysis was performed. Results: Baseline characteristics were similar; however, the VPPx group had more severe primary CDI and were receiving BSAs for more severe infections. There were no cases of CDI recurrence in the VPPx group (0% [0/12] vs 8% [2/24], P = 0.54). Conclusion: Although sufficient power was not obtained to detect statistically significant differences between the intervention and control groups, a 0% incidence of recurrent CDI while receiving VPPx in this high-risk patient population is compelling because it pertains to the avoidance of CDI-related morbidity and mortality in transplant recipients. Future prospective studies are needed to better evaluate the impact of this preventive strategy.