Oral Vancomycin May Prevent Clostridioides Difficile Infection in Transplant Recipients

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There were no cases of C difficile infection in patients who received prophylaxis with vancomycin.
There were no cases of C difficile infection in patients who received prophylaxis with vancomycin.

Oral vancomycin prophylaxis is highly effective in preventing Clostridioides (formerly Clostridium) difficile infection in patients undergoing allogeneic hematopoietic cell transplant (alloHCT) and does not increase the risk for graft-vs-host disease, relapse, or the development of vancomycin-resistant enterococcus (VRE) bloodstream infection, according to findings published in Clinical Infectious Diseases.

Infection remains a leading cause of morbidity and mortality in allogeneic hematopoietic cell transplant recipients. C difficile infection occurs in up to 33% of these patients and has been identified as an independent risk factor for poorer survival. In this retrospective analysis, the effectiveness of oral vancomycin prophylaxis in allogeneic hematopoietic cell transplant recipients was evaluated in 145 patients and associations between vancomycin prophylaxis and other clinical outcomes, including graft-vs-host disease, relapse, and mortality, were also examined. Within this cohort, 90 patients (62%) received oral vancomycin prophylaxis.

No cases of C difficile infection were reported in patients who received oral vancomycin prophylaxis (0/90; 0%), compared to 11 of 55 (20%) patients who were not treated (P <0.001). The time to diagnosis in patients with C difficile infection was approximately 8 days in the control group, and the median length of stay was similar for both groups (29 vs 28 days; P =.22). VRE bloodstream infection developed in 1 patient who received prophylaxis and in 2 patients who did not. At day 180, the cumulative incidence of acute grade 2 through 4 graft-vs-host disease was 39%; bivariable analysis showed that oral vancomycin prophylaxis was not associated with a higher risk. Acute grade 3 or 4 graft-vs-host disease occurred in 12% of the cohort by day 180, but there was also no association with receipt of oral vancomycin prophylaxis (subhazard ratio .65; 95% CI, .25-1.66; P =.36). In addition, researchers found a 28% incidence of relapse of C difficile infection at 1 year after allogeneic hematopoietic cell transplant, which analysis demonstrated was not associated with oral vancomycin prophylaxis (subhazard ratio .80; 95% CI, .43-1.50; P -.50).

“[T]he majority of C difficile infection risk factors in the allogeneic hematopoietic cell transplant population are not modifiable,” wrote the authors, and thus the “high incidence rate and lack of modifiable predisposing factors has created an urgent need to identify novel strategies to mitigate the risk of this infectious complication.”

Reference

Ganetsky A, Han JH, Hughes ME, et al. Oral vancomycin prophylaxis is highly effective in preventing Clostridium difficile infection in allogeneic hematopoietic cell transplant recipients [published online September 26, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy822

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