Oral Vancomycin Prophylaxis as Secondary Prevention Against Clostridioides difficile Infection in the Hematopoietic Stem Cell Transplantation and Hematologic Malignancy Population

•Secondary C. difficile infection was reduced with oral vancomycin prophylaxis.•No difference in vancomycin-resistant Enterococcus rates were seen between groups.•Oral vancomycin prophylaxis seems effective/safe in bone marrow transplant patients Clostridioides difficile infection (CDI) is a common...

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Veröffentlicht in:Biology of blood and marrow transplantation 2019-10, Vol.25 (10), p.2091-2097
Hauptverfasser: Morrisette, Taylor, Van Matre, Amanda G., Miller, Matthew A., Mueller, Scott W., Bajrovic, Valida, Abidi, Maheen Z., Benamu, Esther, Kaiser, Jeffrey N., Barber, Gerard R., Chase, Stephanie, Tobin, Jennifer, Fish, Douglas N., Gutman, Jonathan A.
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Sprache:eng
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Zusammenfassung:•Secondary C. difficile infection was reduced with oral vancomycin prophylaxis.•No difference in vancomycin-resistant Enterococcus rates were seen between groups.•Oral vancomycin prophylaxis seems effective/safe in bone marrow transplant patients Clostridioides difficile infection (CDI) is a common complication in the hematopoietic stem cell transplantation (HSCT) and hematologic malignancy (HM) population. CDI is associated with increased hospital length of stay, health care and societal costs, morbidity, and mortality. Identifying strategies for secondary prevention of CDI is of extreme importance in the HSCT/HM population. In this study, our primary objective was to evaluate the effectiveness and safety of an oral vancomycin prophylaxis (OVP) protocol for secondary prevention of CDI in a retrospective cohort of adult autologous/allogeneic HSCT recipients and patients with HM who did not undergo HSCT with a first CDI episode treated with concomitant broad-spectrum antibiotics (BSA). Patients were diagnosed and treated for CDI as inpatients and/or outpatients and were divided into 2 groups based on a preprotocol versus postprotocol analysis: the OVP group, comprising patients who received planned monotherapy with oral vancomycin 125 mg every 6 hours for 14 days for a first episode of CDI and subsequently received OVP posttreatment and a no OVP (NOVP) group, comprising patients who received planned monotherapy with oral vancomycin 125 mg every 6 hours for 14 days for a first episode of CDI and subsequently did not receive OVP posttreatment. OVP was defined as vancomycin 125 mg every 12 hours for up to 7 days after BSA discontinuation. The primary endpoint was recurrent CDI (rCDI), defined as symptoms of loose stools/diarrhea with high clinical suspicion for CDI prompting empiric therapy within 60 days of completion of treatment/prophylaxis for the first CDI episode. The incidence of vancomycin-resistant enterococcal (VRE) infection and 60-day mortality were also compared between the 2 groups. Multivariate logistic regression was created from associated variables to identify independent associations with rCDI. A total of 50 patients were included, 21 in the OVP group (42%) and 29 in the NOVP group (58%). The mean patient age was 58 years, and the cohort was 60% male and 86% Caucasian. HSCT was performed in 60% of the patients, and 76% of CDI cases were diagnosed during hospitalization. The rate of rCDI was significantly lower in the OVP group compared with
ISSN:1083-8791
1523-6536
DOI:10.1016/j.bbmt.2019.06.021