Secondary Oral Vancomycin Prophylaxis Reduces Risk of Recurrent C Difficile Infection

Lisa Rapaport

August 02, 2021

(Reuters Health) — Pediatric patients with Clostridioides difficile infection (CDI) have a significantly lower risk of recurrence within 8 weeks of antibiotic exposure when they receive secondary oral vancomycin prophylaxis, a small study suggests.

Researchers examined data on patients up to 18 years old who had a history of CDI and had a subsequent antibiotic exposure between 2013 and 2019. The analysis 44 patients who received antibiotics alone and 30 patients who also received oral vancomycin prophylaxis.

Patients who received oral vancomycin prophylaxis had significantly lower incidence of CDI recurrence within 8 weeks (3%) than those who received systemic antibiotics alone (25%). Secondary vancomycin prophylaxis was associated with a significantly lower risk of CDI occurrence in adjusted analysis (odds ratio 0.10).

"I think many clinicians already use oral vancomycin as secondary prophylaxis when giving other antibiotics to patients with a history of C. difficile infection," said Dr. Daniel Caroff, an infectious disease physician and hospital epidemiologist at Lahey Hospital and Medical Center and an assistant professor at Tufts University School of Medicine in Boston.

Some previous studies in adults have shown the benefit of this treatment protocol, Dr. Caroff, who wasn't involved in the study, said by email.

"The idea is that suppressing growth of the C. difficile bacteria during a time of high risk may prevent it from causing infection," Dr. Caroff said. "People with recent C. difficile infections are likely to carry the bacteria without symptoms and are at increased risk of recurrence, especially if exposed to antibiotics."

Many of the children in the study were high-risk for CDI infections because they had cancer, received stem cell transplants, required feeding tubes, or were immunosuppressed.

Most were hospitalized at the time of study inclusion or had been hospitalized within the previous 30 days. In addition, most had used systemic antibiotics within the past three months.

Beyond its small size, another limitation of the study is the lack of detailed medical information on individual patients due to the use of claims data, the authors write in Pediatrics. In addition, it's possible that some patients received treatment for recurrent CDI from out-of-network providers, with those encounters excluded from claims data.

The study was also conducted within a single healthcare system, and results might differ elsewhere, noted the authors, led by Hongkai Bao of Montefiore Medical Center in New York City, who didn't respond to email seeking comment.

The study results suggest that clinicians should consider oral vancomycin as prophylaxis against recurrent CDI, particularly in patients at high-risk for recurrence, said Dr. Michael Klompas, a hospital epidemiologist at Brigham and Women's Hospital and a professor of population medicine at Harvard Medical School in Boston.

"We know that patients with a prior history of CDI are at high risk for recurrent disease and that exposure to antibiotics increases the risk of CDI recurrence," Dr. Klompas, who wasn't involved in the study, said by email. "We also know, though, that vancomycin is active against this pathogen, so the observed decrease in recurrent CDI does make sense."

SOURCE: Pediatrics, online July 30, 2021.