scholarly journals Effectiveness of fidaxomicin versus oral vancomycin in the treatment of recurrent clostridioides difficile

2021 ◽  
Author(s):  
Alyssa Rinaldi ◽  
Erica E. Reed ◽  
Kurt B. Stevenson ◽  
Kelci Coe ◽  
Jessica M. Smith
Keyword(s):  
Oral Vancomycin ◽  
Clostridioides Difficile

scholarly journals 1376. Oral Vancomycin as Secondary Prophylaxis Against Clostridioides difficile Infection in Pediatric Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S698-S698
Author(s):  
Hongkai Bao ◽  
Yanina Dubrovskaya ◽  
John Papadopoulos ◽  
Justin Siegfried ◽  
Cristian Merchan ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Protective Factor ◽  
Pediatric Patients ◽  
Antibiotic Exposure ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
History Of ◽  
Systemic Antibiotics

Abstract Background Secondary oral vancomycin prophylaxis (OVP) has been utilized in adults with a history of Clostridioides difficile infection (CDI) while receiving systemic antibiotics to prevent CDI recurrence. However, this practice is poorly described in pediatric patients. Rates of CDI recurrence in pediatric patients range from 10-40% and is associated with morbidity and mortality. This study assessed the efficacy and safety of secondary OVP in pediatric patients with subsequent antibiotic exposure. Methods This retrospective study evaluated pediatric patients ≤18 years with any history of clinical CDI and receiving systemic antibiotics in a subsequent encounter during the time period of 2013-2019. Patients who received OVP 10 mg/kg (up to 125 mg per dose) every 12 hours during concomitant antibiotics were compared to those who did not. The primary outcome was CDI recurrence within 8 weeks following antibiotic exposure. Secondary outcomes included time to recurrence, severity of recurrence, and isolation of vancomycin-resistant enterococci (VRE) from any site. Risk factors for CDI recurrence were assessed using logistic regression. Results A total of 153 patients were screened for inclusion, of which 32 and 47 patients were assigned to the OVP and no OVP group, respectively. Median age was 8.6 years and the most common comorbidities were malignancy (47%) and immunosuppression (46%). Median time since last CDI to study inclusion was 64.5 days in the OVP group and 90 days in the no OVP group, P=0.320. Compared to the no OVP group, OVP patients had longer hospital stays (5 vs 14 days, P=0.001) and more concomitant antibiotic exposure (8 vs 12.5 days, P=0.001). Median duration of OVP was 12 days. CDI recurrence occurred in 12 patients and was significantly lower in the OVP vs no OVP group (3.1% vs 23.4%; odds ratio, 0.106; 95% confidence interval, 0.013-0.864; P=0.022). VRE was not isolated in any patients. After adjustment in a multivariate analysis, only secondary OVP remained as a protective factor against recurrence (odds ratio, 0.082; 95% confidence interval, 0.009-0.748; P=0.027). Conclusion Secondary OVP effectively reduces the risk of recurrent CDI in pediatric patients with a history of CDI while receiving systemic antibiotics. Future prospective studies should validate these findings. Disclosures Cristian Merchan, PharMD, BCCCP, abbive (Speaker’s Bureau)

scholarly journals 785. Association between Prevalence of Laboratory-Identified Clostridioides difficile Infections (CDIs) and CDI Antibiotic Treatment in U.S. Acute Care Hospitals, 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S437-S437
Author(s):  
Kerui Xu ◽  
Andrea L Benin ◽  
Hsiu Wu ◽  
Jonathan R Edwards ◽  
Qunna Li ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Prevalence Rates ◽  
Hospital Level ◽  
First Line ◽  
Oral Vancomycin ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract Background Clostridioides difficile infections (CDIs) are an urgent public health threat, accounting for 223,900 infections and 12,800 deaths in hospitalized patients annually. In early 2018, the Infectious Disease Society of America (IDSA) recommended oral vancomycin or fidaxomicin as the first-line antibiotics for CDIs. To track the uptake of IDSA’s recommendations, we evaluated the association between CDI prevalence and use of first-line antibiotics in hospitals reporting to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN). Methods We matched 2018 hospital-level, NHSN data on laboratory-identified CDIs with NHSN antimicrobial use (AU) data for the same time period. Hospitals that submitted < 6 months of either data type in 2018 were excluded. The association between quarterly hospital-level CDI prevalence rates per 100 patient-admissions and use of CDI antibiotics (oral vancomycin plus fidaxomicin) per 1,000 days-present was evaluated using Pearson’s linear correlation coefficient and using Goodman and Kruskal’s gamma (G) on ordinal quartiles to assess rates of discordant pairs. Results Among the 2735 hospital-level quarters based on 714 hospitals included in the study, CDI prevalence (median: 0.46 per 100 patient-admissions) and CDI antibiotic use (median: 8.85 antibiotic-days per 1,000 days-present) demonstrated only a moderately positive correlation (r = 0.48). Among hospitals in the highest quartile for CDI prevalence, 5.1% were in the lowest quartile for antibiotic use. Among hospitals in the highest quartile for antibiotic use, 5.3% were in the lowest quartile for CDI prevalence, and 54.2% were in the highest quartile for CDI prevalence (G = 0.60; 95% CI: 0.57–0.63). Correlation of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in U.S. acute care hospitals, 2018 Distribution of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in ordinal quartiles (Q1–Q4) to access rates of discordant pairs Conclusion The moderate correlation and discordant rates suggest that vancomycin and fidaxomicin are less frequently used as primary antibiotics in some hospitals; whereas in others, CDI antibiotic use is occurring in the absence of positive laboratory tests for CDI. To further investigate this discordance, there is a need to assess hospitals’ prescribing and testing practices in an ongoing manner. These findings may be useful to serve as baseline for measuring progress of appropriateness of treatment and testing for CDIs. Disclosures All Authors: No reported disclosures

Dose addition of intravenous metronidazole to oral vancomycin improve outcomes in Clostridioides difficile infection?

2019 ◽  
Author(s):  
Ying Wang ◽  
Aaron Schluger ◽  
Jianhua Li ◽  
Angela Gomez-Simmonds ◽  
Hojjat Salmasian ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Primary Outcome ◽  
Time Window ◽  
Dual Therapy ◽  
Secondary Outcome ◽  
Index Test ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Improved Outcomes ◽  
Clostridioides Difficile Infection

Abstract Background Guidelines recommend adding intravenous (IV) metronidazole to oral vancomycin for fulminant Clostridioides difficile infection (CDI). This study compared dual therapy with IV metronidazole and oral vancomycin versus vancomycin monotherapy. It assessed prevalence of use and effectiveness of dual therapy in non-fulminant and fulminant CDI. Methods This was a two-center retrospective study conducted from 2010 to 2018. Adult inpatients were included if they had a positive C. difficile PCR performed on an unformed stool and received oral vancomycin within two days (either before or after) of testing. Patients were classified as having received dual therapy if IV metronidazole was given within the same time window, and otherwise as having received vancomycin monotherapy. The primary outcome was  death or colectomy within 90 days after the index test. Logistic regression modeling was used to adjust for CDI severity and other established predictors of CDI outcomes. CDI recurrence was examined as a secondary outcome, adjusting for death as a competing risk. Results The study included 2,114 patients (dual therapy: 993; monotherapy: 1,121) of whom 23% met the primary outcome. There was no association between dual therapy and the primary outcome (adjusted OR (aOR) 1.07, 95% CI 0.79-1.45) which remained true when the analysis was restricted to patients with fulminant CDI (aOR 1.17, 95% CI 0.65-2.10). There was also no association between dual therapy and CDI recurrence. Conclusions Dual therapy with IV metronidazole and oral vancomycin was common for non-fulminant and fulminant CDI, but was not associated with improved outcomes compared to vancomycin alone.

Oral Vancomycin as Secondary Prophylaxis for Clostridioides difficile Infection

PEDIATRICS ◽  
2021 ◽  
pp. e2020031807
Author(s):  
Hongkai Bao ◽  
Jennifer Lighter ◽  
Yanina Dubrovskaya ◽  
Cristian Merchan ◽  
Justin Siegfried ◽  
...  
Keyword(s):  
Secondary Prophylaxis ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

scholarly journals 2437. First-line Fidaxomicin Use in High-risk Inpatients Reduces Recurrence Rates

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S842-S842
Author(s):  
Rose Kohinke ◽  
Lauren McDaniel ◽  
Angela Perhac ◽  
Nathan Everson
Keyword(s):  
High Risk ◽  
Clinical Decision ◽  
First Episode ◽  
First Line ◽  
Oral Vancomycin ◽  
Recurrence Rates ◽  
Clostridioides Difficile ◽  
Quasi Experimental ◽  
The Impact ◽  
Order Set

Abstract Background Fidaxomicin is recommended by the 2018 Infectious Diseases Society of America (IDSA) guidelines as a first-line treatment in adult patients with uncomplicated Clostridioides difficile infection (CDI). Carilion Roanoke Memorial Hospital (CRMH) implemented a clinical decision order set directing providers to initiate fidaxomicin for CDI in patients at high risk of recurrence. The purpose of this study was to assess the impact of fidaxomicin on patient outcomes. Methods This quasi-experimental study included adults with a first episode or first recurrence of CDI before and after order set implementation. Patients receiving laxatives within 24 hours of testing and those with fulminant CDI were excluded. Pre-implementation was defined as May 2017 to November 2017 and post-implementation as May 2018 to November 2018. The primary endpoint was recurrence (diarrhea and a positive GDH with toxin or PCR within 30 days post-treatment). Secondary endpoints were clinical cure (resolution of symptoms within 2 days of completing therapy), global cure (cure with no recurrence at 3 months), mortality, and readmissions. Partial courses of fidaxomicin (i.e., patients discharged on another agent) were also evaluated. Results A total of 282 patients were included. In the pre-group, 59.1% received metronidazole, 39.6% oral vancomycin, and 1.3% fidaxomicin. In the post-group, fidaxomicin use increased to 52.3% and oral vancomycin was 44.5%. There was a significant improvement in recurrence (30.2% vs 17.1%, P = 0.019). Global cure and CDI upon readmission also improved in the post-group (Table 1). In patients receiving partial courses of fidaxomicin, recurrence (9.3% vs 25%, P = 0.19), global cure (86% vs 75%, P = 0.44), and infection on readmission (28.6% vs 37.5%, P = 0.67) were similar. Conclusion Fidaxomicin as a first-line agent in high-risk CDI patients decreased recurrence and increased global cure. Disclosures All authors: No reported disclosures.

Oral vancomycin prophylaxis during systemic antibiotic exposure to preventClostridiodes difficileinfection relapses

2019 ◽  
Vol 40 (6) ◽  
pp. 662-667 ◽  
Author(s):  
Daniel A. Caroff ◽  
John T. Menchaca ◽  
Zilu Zhang ◽  
Chanu Rhee ◽  
Michael S. Calderwood ◽  
...  
Keyword(s):  
Group Versus ◽  
Probability Weighting ◽  
Oral Vancomycin ◽  
Unadjusted Odds Ratio ◽  
Inverse Probability ◽  
Clostridioides Difficile ◽  
History Of ◽  
Secondary Analyses ◽  
Systemic Antibiotics ◽  
Relapse Rates

AbstractObjective:To determine whether oral vancomycin prophylaxis accompanying systemic antibiotics reduces the risk of relapse in patients with history ofClostridioides difficileinfection (CDI).Design:Retrospective cohort study.Patients:Adult inpatients with a history of CDI who received systemic antibiotics in either of 2 hospitals between January 2009 and June 2015.Methods:We compared relapse rates in patients who started oral vancomycin concurrently with systemic antibiotics (exposed group) versus those who did not. We assessed for CDI relapse by toxin or nucleic acid testing at 90 days. We used inverse probability weighting and machine learning to adjust for confounders, to estimate propensity for treatment, and to calculate odds ratios for CDI relapse. We performed secondary analyses limited to toxin-positive relapses, patients with 1 versus >1 prior CDI episodes, and patients who received oral vancomycin on each antibiotic day.Results:CDI relapse occurred within 90 days in 19 of 193 exposed patients (9.8%) versus 53 of 567 unexposed patients (9.4%; unadjusted odds ratio [OR], 1.06; 95% confidence interval [CI], 0.60–1.81; adjusted OR, 0.63; 95% CI, 0.35–1.14). CDI relapses at 90 days were less frequent in exposed patients with only 1 prior episode of CDI (OR, 0.42; 95% CI, 0.19–0.93) but not in those with >1 prior episode (OR, 1.19; 95% CI, 0.42–3.33). Our findings were consistent with a lack of benefit of oral vancomycin when restricting results to toxin-positive relapses and to patients who received vancomycin each antibiotic day.Conclusions:Prophylactic oral vancomycin was not consistently associated with reduced risk of CDI relapse among hospitalized patients receiving systemic antibiotics. However, patients with only 1 prior CDI episode may benefit.

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