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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

Diana Kwiatkowski ,
Kassandra Marsh Open the ORCID record for Kassandra Marsh [Opens in a new window] ,
Alyson Katz ,
John Papadopoulos ,
Jonathan So ,
Vincent J. Major Open the ORCID record for Vincent J. Major [Opens in a new window] ,
Philip M. Sommer ,
Sarah Hochman Open the ORCID record for Sarah Hochman [Opens in a new window] ,
Yanina Dubrovskaya  and
Serena Arnouk Open the ORCID record for Serena Arnouk [Opens in a new window]
Diana Kwiatkowski
Affiliation:
Department of Pharmacy, NYU Langone Health, New York, New York
Kassandra Marsh
Affiliation:
Department of Pharmacy, NYU Langone Health, New York, New York
Alyson Katz
Affiliation:
Department of Pharmacy, NYU Langone Health, New York, New York
John Papadopoulos
Affiliation:
Department of Pharmacy, NYU Langone Health, New York, New York
Jonathan So
Affiliation:
Department of Population Health, NYU Langone Health, New York, New York
Vincent J. Major
Affiliation:
Department of Population Health, NYU Langone Health, New York, New York
Philip M. Sommer
Affiliation:
Department of Anesthesiology, NYU Langone Health, New York, New York
Sarah Hochman
Affiliation:
Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Health, New York, New York
Yanina Dubrovskaya
Affiliation:
Department of Pharmacy, NYU Langone Health, New York, New York
Serena Arnouk*
Affiliation:
Department of Pharmacy, NYU Langone Health, New York, New York
*
Corresponding author: Serena Arnouk; Email: serena.arnouk@nyulangone.org
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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.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 45 , Issue 6 , June 2024 , pp. 717 - 725
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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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).

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