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Oral vancomycin prophylaxis for the prevention of Clostridium difficile infection: A systematic review and meta-analysis

Published online by Cambridge University Press:  29 June 2020

Sumbal Babar ,
Bara El Kurdi Open the ORCID record for Bara El Kurdi [Opens in a new window] ,
Mahmoud El Iskandarani ,
Ibrahim Haddad ,
Zaid Imam Open the ORCID record for Zaid Imam [Opens in a new window] ,
Mohammad Alomari ,
James Myers  and
Jonathan Moorman
Sumbal Babar
Affiliation:
Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
Bara El Kurdi*
Affiliation:
Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
Mahmoud El Iskandarani
Affiliation:
Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
Ibrahim Haddad
Affiliation:
Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
Zaid Imam
Affiliation:
Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan
Mohammad Alomari
Affiliation:
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
James Myers
Affiliation:
Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee Division of Infectious Diseases, East Tennessee State University, Johnson City, Tennessee
Jonathan Moorman
Affiliation:
Division of Infectious Diseases, East Tennessee State University, Johnson City, Tennessee
*
Author for correspondence: Bara El Kurdi, E-mail: Baraabayern@gmail.com
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Abstract

Objective:

Recently, oral vancomycin prophylaxis (OVP) has been suggested for the prevention of Clostridium difficile infection (CDI). We conducted a systematic review and meta-analysis to investigate the efficacy and safety of this approach.

Design:

Systematic review and meta-analysis.

Methods:

We conducted a computerized search of MEDLINE, EMBASE, and Cochrane databases from inception to March 2019 for publications investigating OVP for CDI prevention. Results were screened for eligibility. Relevant data were extracted and analyzed. Publication bias was assessed using the Egger test.

Results:

Ultimately, 8 retrospective studies and 1 prospective study examining 2174 patients, published between 2016 and 2019 were included in the review. OVP was associated with decreased CDI (odds ratio, 0.263; 95% confidence interval, 0.13–0.52) with considerable heterogeneity (I2 = 61%). Meta-regression showed that total daily dose of OVP correlated with CDI, explaining 100% of heterogeneity between studies. Furthermore, 3 studies evaluated the risk of vancomycin-resistant enterococci (VRE) infection after OVP and found no significant increase.

Conclusion:

Our results suggest that OVP might decrease CDI rates in at-risk populations, although this conclusion should be interpreted with caution. Higher daily doses of OVP might increase CDI. Although the use of OVP in high-risk patients may reduce CDI, this suggestion has yet to be validated by prospective blinded randomized controlled trials.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 11 , November 2020 , pp. 1302 - 1309
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of healthcare-associated infections. N Engl J Med 2014;370:1198–1208.10.1056/NEJMoa1306801CrossRefGoogle Scholar
Desai, K, Gupta, SB, Dubberke, ER, et al. Epidemiological and economic burden of Clostridium difficile in the United States: estimates from a modeling approach. BMC Infect Dis 2016;16:303.10.1186/s12879-016-1610-3CrossRefGoogle ScholarPubMed
Pepin, J, Alary, M-E, Valiquette, L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 2005;40:1591–1597.10.1086/430315CrossRefGoogle ScholarPubMed
Ofosu, A. Clostridium difficile infection: a review of current and emerging therapies. Ann Gastroenterol 2016;29:147–154.10.20524/aog.2016.0006CrossRefGoogle ScholarPubMed
McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile . N Engl J Med 2005;353:2433–2441.10.1056/NEJMoa051590CrossRefGoogle ScholarPubMed
Bartlett, JG. Narrative review: the new epidemic of Clostridium difficile–associated enteric disease. Ann Intern Med 2006;145:758–764.10.7326/0003-4819-145-10-200611210-00008CrossRefGoogle ScholarPubMed
Musher, DM, Aslam, S, Logan, N, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 2005;40:1586–1590.10.1086/430311CrossRefGoogle ScholarPubMed
Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.10.1056/NEJMoa1408913CrossRefGoogle ScholarPubMed
Rodrigues, R, Barber, GE, Ananthakrishnan, AN. A comprehensive study of costs associated with recurrent Clostridium difficile infection. Infect Control Hosp Epidemiol 2017;38:196–202.10.1017/ice.2016.246CrossRefGoogle ScholarPubMed
Butler, M, Olson, A, Drekonja, D, et al. Early diagnosis, prevention, and treatment of Clostridium difficile: update. Agency for Healthcare Research and Quality website. http://www.ncbi.nlm.nih.gov/books/NBK361173/. Published 2016. Accessed May 5, 2019.Google Scholar
Chapin, RW, Lee, T, McCoy, C, et al. Bezlotoxumab: could this be the answer for Clostridium difficile recurrence? Ann Pharmacother 2017;51:804–810.10.1177/1060028017706374CrossRefGoogle ScholarPubMed
Pepin, J, Alary, M-E, Valiquette, L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 2005;40:1591–1597.10.1086/430315CrossRefGoogle ScholarPubMed
Leav, BA, Blair, B, Leney, M, et al. Serum anti-toxin B antibody correlates with protection from recurrent Clostridium difficile infection (CDI). Vaccine 2010;28:965–969.10.1016/j.vaccine.2009.10.144CrossRefGoogle Scholar
Hu, MY, Katchar, K, Kyne, L, et al. Prospective derivation and validation of a clinical prediction rule for recurrent Clostridium difficile infection. Gastroenterology 2009;136:1206–1214.10.1053/j.gastro.2008.12.038CrossRefGoogle ScholarPubMed
Abou Chakra, CN, Pepin, J, Sirard, S, et al. Risk factors for recurrence, complications and mortality in Clostridium difficile infection: a systematic review. PLoS One 2014;9:e98400.10.1371/journal.pone.0098400CrossRefGoogle ScholarPubMed
Liberati, A, Altman, DG, Tetzlaff, J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700.10.1136/bmj.b2700CrossRefGoogle ScholarPubMed
Stroup, DF, Berlin, JA, Morton, SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 2000;283:2008–2012.10.1001/jama.283.15.2008CrossRefGoogle Scholar
Ottawa Hospital Research Institute website. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed April 3, 2019.Google Scholar
Van Hise, NW, Bryant, AM, Hennessey, EK, et al. Efficacy of oral vancomycin in preventing recurrent Clostridium difficile infection in patients treated with systemic antimicrobial agents. Clin Infect Dis 2016;63:651–653.10.1093/cid/ciw401CrossRefGoogle ScholarPubMed
Carignan, A, Poulin, S, Martin, P, et al. Efficacy of secondary prophylaxis with vancomycin for preventing recurrent Clostridium difficile infections. Am J Gastroenterol 2016;111:1834–1840.10.1038/ajg.2016.417CrossRefGoogle ScholarPubMed
Knight, EM, Schiller, DS, Fulman, MK, et al. Long-term efficacy of oral vancomycin prophylaxis for the prevention of Clostridium difficile recurrence. J Pharm Pract 2019. doi: 10.1177/0897190019825994.CrossRefGoogle Scholar
Caroff, DA, Menchaca, JT, Zhang, Z, et al. Oral vancomycin prophylaxis during systemic antibiotic exposure to prevent Clostridiodes difficile infection relapses. Infect Control Hosp Epidemiol 2019;40:662–667.10.1017/ice.2019.88CrossRefGoogle ScholarPubMed
Splinter, LE, Kerstenetzky, L, Jorgenson, MR, et al. Vancomycin prophylaxis for prevention of Clostridium difficile infection recurrence in renal transplant patients. Ann Pharmacother 2018;52:113–119.10.1177/1060028017727756CrossRefGoogle ScholarPubMed
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. Clin Infect Dis 2019;68:2003–2009.CrossRefGoogle ScholarPubMed
Morrisette, T, Van Matre, AG, Miller, MA, et al. Oral vancomycin prophylaxis as secondary prevention against Clostridioides difficile infection in the hematopoietic stem cell transplantation and hematologic malignancy population. Biol Blood Marrow Transplant 2019;25:2091–2097.10.1016/j.bbmt.2019.06.021CrossRefGoogle ScholarPubMed
Papic, N, Maric, LS, Vince, A. Efficacy of oral vancomycin in primary prevention of Clostridium difficile infection in elderly patients treated with systemic antibiotic therapy. Infect Dis 2018;50:483–486.10.1080/23744235.2018.1425551CrossRefGoogle ScholarPubMed
Johnson, SW, Brown, SV, Priest, DH. Effectiveness of oral vancomycin for prevention of healthcare facility-onset Clostridioides difficile infection in targeted patients during systemic antibiotic exposure. Clin Infect Dis 2019. doi: 10.1093/cid/ciz966.CrossRefGoogle Scholar
Carignan, A, Poulin, S, Martin, P, et al. Efficacy of secondary prophylaxis with vancomycin for preventing recurrent Clostridium difficile infections. Am J Gastroenterol 2016;111:1834–1840.10.1038/ajg.2016.417CrossRefGoogle ScholarPubMed
Knight, EM, Schiller, DS, Fulman, MK, et al. Long-term efficacy of oral vancomycin prophylaxis for the prevention of Clostridium difficile recurrence. J Pharm Pract 2019. doi: 10.1177/0897190019825994.CrossRefGoogle Scholar
Isaac, S, Scher, JU, Djukovic, A, et al. Short- and long-term effects of oral vancomycin on the human intestinal microbiota. J Antimicrob Chemother 2017;72:128–136.10.1093/jac/dkw383CrossRefGoogle Scholar
Ajami, NJ, Cope, JL, Wong, MC, et al. Impact of oral fidaxomicin administration on the intestinal microbiota and susceptibility to Clostridium difficile colonization in mice. Antimicrob Agent Chemother 2018;62:e02112–17.10.1128/AAC.02112-17CrossRefGoogle ScholarPubMed
Johnson, S, Homann, SR, Bettin, KM, et al. Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. A randomized, placebo-controlled trial. Ann Intern Med 1992;117:297–302.10.7326/0003-4819-117-4-297CrossRefGoogle ScholarPubMed
Edlund, C, Barkholt, L, Olsson-Liljequist, B, et al. Effect of vancomycin on intestinal flora of patients who previously received antimicrobial therapy. Clin Infect Dis 1997;25:729–732.10.1086/513755CrossRefGoogle ScholarPubMed
Shin, JW, Yong, D, Kim, MS, et al. Sudden increase of vancomycin-resistant enterococcal infections in a Korean tertiary-care hospital: possible consequences of increased use of oral vancomycin. J Infect Chemother 2003;9:62–67.10.1007/s10156-002-0215-5CrossRefGoogle Scholar
Tomas, ME, Mana, TSC, 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(5). doi: 10.1128/AAC.02237-17.CrossRefGoogle Scholar
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