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Impact of oral vancomycin treatment duration on rate of Clostridioides difficile recurrence in patients requiring concurrent systemic antibiotics
Published online by Cambridge University Press: 30 January 2024
Abstract
Background:
There is a paucity of data guiding treatment duration of oral vancomycin for Clostridiodes difficile infection (CDI) in patients requiring concomitant systemic antibiotics.
Objectives:
To evaluate prescribing practices of vancomycin for CDI in patients that required concurrent systemic antibiotics and to determine whether a prolonged duration of vancomycin (>14 days), compared to a standard duration (10–14 days), decreased CDI recurrence.
Methods:
In this retrospective cohort study, we evaluated adult hospitalized patients with an initial episode of CDI who were treated with vancomycin and who received overlapping systemic antibiotics for >72 hours. Outcomes of interest included CDI recurrence and isolation of vancomycin-resistant Enterococcus (VRE).
Results:
Among the 218 patients included, 36% received a standard duration and 64% received a prolonged duration of treatment for a median of 13 days (11–14) and 20 days (16–26), respectively. Patients who received a prolonged duration had a longer median duration of systemic antibiotic overlap with vancomycin (11 vs 8 days; P < .001) and significantly more carbapenem use and infectious disease consultation. Recurrence at 8 weeks (12% standard duration vs 8% prolonged duration; P = .367), recurrence at 6 months (15% standard duration vs 10% prolonged duration; P = .240), and VRE isolation (3% standard duration vs 9% prolonged duration; P = .083) were not significantly different between groups. Discontinuation of vancomycin prior to completion of antibiotics was an independent predictor of 8-week recurrence on multivariable logistic regression (OR, 4.8; 95% CI, 1.3–18.1).
Conclusions:
Oral vancomycin prescribing relative to the systemic antibiotic end date may affect CDI recurrence to a greater extent than total vancomycin duration alone. Further studies are needed to confirm these findings.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
Footnotes
PREVIOUS PRESENTATION. This study was presented as a poster at IDWeek 2023 on October 12, 2023, in Boston, Massachusetts, and the corresponding abstract was published in Open Forum Infectious Diseases journal (Abstract citation ID: ofad500.720).
References
Magill, SS, O’Leary, E, Janelle, SJ, et al. Changes in prevalence of healthcare-associated infections in US hospitals. N Engl J Med 2018;379:1732–1744.CrossRefGoogle Scholar
Emerging Infections Program, healthcare-associated infections—community interface surveillance report, Clostridioides difficile infection (CDI), 2020. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/eip/pdf/cdiff/2020-CDI-Report-H.pdf. Published 2020. Accessed January 15, 2024.Google Scholar
Feuerstadt, P, Theriault, N, Tillotson, G. The burden of CDI in the United States: a multifactorial challenge. BMC Infect Dis 2023;23:132.CrossRefGoogle ScholarPubMed
Brown, KA, Khanafer, N, Daneman, N, Fisman, DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother 2013;57:2326–2332.CrossRefGoogle ScholarPubMed
Deshpande, A, Pasupuleti, V, Thota, P, et al. Risk factors for recurrent Clostridium difficile infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2015;36:452–460.CrossRefGoogle ScholarPubMed
Song, JH, Kim, YS. Recurrent Clostridium difficile infection: risk factors, treatment, and prevention. Gut Liver 2019;13:16–24.CrossRefGoogle ScholarPubMed
Finn, E, Andersson, FL, Madin-Warburton, M. Burden of Clostridioides difficile infection (CDI)—a systematic review of the epidemiology of primary and recurrent CDI. BMC Infect Dis 2021;21:456.CrossRefGoogle Scholar
Mullane, KM, Miller, MA, Weiss, K, et al. Efficacy of fidaxomicin versus vancomycin as therapy for Clostridium difficile infection in individuals taking concomitant antibiotics for other concurrent infections. Clin Infect Dis 2011;53:440–447.CrossRefGoogle ScholarPubMed
Fitzpatrick, F, Safdar, N, van Prehn, J, Tschudin-Sutter, S. How can patients with Clostridioides difficile infection on concomitant antibiotic treatment be best managed? Lancet Infect Dis 2022;22:e336–e340.CrossRefGoogle ScholarPubMed
Cornely, OA, Crook, DW, Esposito, R, et al. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, noninferiority, randomised controlled trial. Lancet Infect Dis 2012;12:281–289.CrossRefGoogle Scholar
Louie, TJ, Miller, MA, Mullane, KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011;364:422–431.CrossRefGoogle ScholarPubMed
Mikamo, H, Tateda, K, Yanagihara, K, et al. Efficacy and safety of fidaxomicin for the treatment of Clostridioides (Clostridium) difficile infection in a randomized, double-blind, comparative phase III study in Japan. J Infect Chemother 2018;24:744–752.CrossRefGoogle Scholar
Guery, B, Menichetti, F, Anttila, VJ, et al. Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older (EXTEND): a randomised, controlled, open-label, phase 3b/4 trial. Lancet Infect Dis 2018;18:296–307.CrossRefGoogle ScholarPubMed
Keats, KR, Stitt, TM, Chastain, DB, et al. Evaluating Clostridioides difficile infection (CDI) treatment duration in hematology/oncology patients receiving concurrent non-CDI antibiotics. J Oncol Pharm Pract 2022;28:542–550.CrossRefGoogle Scholar
Rajakumar, I, Jaber, R, Ali, R, Rennert-May, E, Sabuda, D. Impact of C. difficile length of treatment on rates of recurrence in patients on concurrent antibiotics. Am J Infect Control 2023. doi: 10.1016/j.ajic.2023.04.167.CrossRefGoogle Scholar
Kaki, RM, Brooks, AA, Main, C, Jayaratne, P, Mertz, D. Does extending Clostridium difficile treatment in patients who are receiving concomitant antibiotics reduce the rate of relapse. Internet J Infect Dis 2016;15.Google Scholar
Johnson, S, Lavergne, V, Skinner, AM, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clin Infect Dis 2021;73:755–757.CrossRefGoogle Scholar
National Healthcare Saftety Network. Multidrug-resistant organism and Clostridioides difficile infection (MDRO/CDI) module. https://www.cdc.gov/nhsn/pdfs/pscmanual/12pscmdro_cdadcurrent.pdf. Published 2023. Accessed January 15, 2024.Google Scholar
IBM SPSS Statistics version 28.0 software for Windows. Armonk, NY: IBM; 2021.Google Scholar
Quan, H, Sundararajan, V, Halfon, P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:1130–1139.CrossRefGoogle ScholarPubMed
Reveles, KR, Pugh, MJV, Lawson, KA, et al. Shift to community-onset Clostridium difficile infection in the national Veterans’ Health Administration, 2003–2014. Am J Infect Control 2018;46:431–435.CrossRefGoogle ScholarPubMed
Di, X, Bai, N, Zhang, X, et al. A meta-analysis of metronidazole and vancomycin for the treatment of Clostridium difficile infection, stratified by disease severity. Braz J Infect Dis 2015;19:339–349.CrossRefGoogle ScholarPubMed
Maraolo, AE, Mazzitelli, M, Zappulo, E, et al. Oral vancomycin prophylaxis for primary and secondary prevention of Clostridioides difficile infection in patients treated with systemic antibiotic therapy: a systematic review, meta-analysis and trial sequential analysis. Antibiotics (Basel) 2022;11:183.CrossRefGoogle ScholarPubMed
Johnson, M, Doll, M, Snider, K. Outcomes in prolonged treatment of Clostridium difficile infections with concurent antibiotic use. Crit Care Med 2018;46:308.CrossRefGoogle Scholar
Tomas, ME, Mana, TS, Wilson, BM, et al. Tapering courses of oral vancomycin induce persistent disruption of the microbiota that provide colonization resistance to Clostridium difficile and vancomycin-resistant enterococci in mice. Antimicrob Agents Chemother 2018;62:1–9.CrossRefGoogle ScholarPubMed
Al-Nassir, WN, Sethi, AK, Li, Y, Pultz, MJ, Riggs, MM, Donskey, CJ. Both oral metronidazole and oral vancomycin promote persistent overgrowth of vancomycin-resistant enterococci during treatment of Clostridium difficile–associated disease. Antimicrob Agents Chemother 2008;52:2403–2406.CrossRefGoogle ScholarPubMed
Sethi, AK, Al-Nassir, WN, Nerandzic, MM, Donskey, CJ. Skin and environmental contamination with vancomycin-resistant enterococci in patients receiving oral metronidazole or oral vancomycin treatment for Clostridium difficile–associated disease. Infect Control Hosp Epidemiol 2009;30:13–17.CrossRefGoogle ScholarPubMed
Gonzales, M, Pepin, J, Frost, EH, et al. Faecal pharmacokinetics of orally administered vancomycin in patients with suspected Clostridium difficile infection. BMC Infect Dis 2010;10:363.CrossRefGoogle ScholarPubMed
Kwiatkowski et al. supplementary material
Kwiatkowski et al. supplementary material
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