Effect of vancomycin dose on treatment outcomes in severe Clostridium difficile infection

Lam, Simon W.; Bass, Stephanie; Neuner, Elizabeth; Bauer, Seth

doi:10.1016/j.ijantimicag.2013.08.013

Cited by 27 publications

(29 citation statements)

References 28 publications

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“…Furthermore, oral vancomycin, especially if higher dosages are used, also may cause delayed intestinal tissue injury that may act as an additional driver for microbial translocation (37). Our data suggest avoiding the use of increased oral vancomycin dosages and confirm previous observations (38).…”

Section: Discussionsupporting

confidence: 88%

Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection

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Iraci

et al. 2016

Antimicrob Agents Chemother

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We determined the incidence, risk factors, and outcomes of bloodstream infections (BSI) subsequent to Clostridium difficile infection (CDI). We performed a retrospective study of all patients with definite diagnosis of CDI admitted from January 2014 to December 2014 in two large hospitals in Rome. C lostridium difficile infection (CDI) is an emerging infection, usually occurring after exposure to broad-spectrum antibiotics (1-3). This infection can be mild and self-limiting but might progress to severe disease with ileus, toxic megacolon, and eventually, death. The incidence, severity, and acquisition of infection of people formerly classified as being at low risk seem to be increasing, and a hypervirulent, fluoroquinolone-resistant C. difficile strain, named NAP1/BI/027, is associated with severe symptoms, high recurrence rates, and poor outcomes (4-6).The alterations occurring in the intestinal flora, which is recognized as a microbiome, may promote the translocation of pathogens in the blood and the development of nosocomial bloodstream infections (BSIs) (7). Recently, we reported our experience of studying candidemia subsequent to severe CDI (8-10), and we observed an association between Candida species BSI and CDI, especially if caused by ribotype 027 strains. We reported a case of severe community-onset health care-associated CDI complicated by carbapenemase-producing Klebsiella pneumoniae BSI (11). Thus, it was hypothesized that antibiotic therapy and/or other clinical characteristics related to CDI (i.e., severity, recurrence, disease caused by a highly virulent strain, etc.) contribute to alterations of the colon indigenous microbiota and eventually predispose patients to .The aim of our study was to analyze the clinical findings for patients with CDI and primary nosocomial BSI to determine the risk factors and outcomes associated with these infections.(This work was presented as an oral communication during the 55th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, CA, 17 to 21 September 2015 [15].) MATERIALS AND METHODSStudy design and study patients. This was a retrospective study of patients who were admitted from January 2014 to December 2014 to two large hospitals in Rome: Policlinico Umberto I-Sapienza University Hospital (1,200 beds and 49,000 admissions/year in 2014) and the San Giovanni-Addolorata Hospital (700 beds and 30,000 admissions/year in 2014). All adults (aged Ͼ18 years) with a documented CDI initially were included in the study. Patients for whom we could not obtain medical records were excluded from the final analysis. The ethics committee of the Policlinico Umberto I approved the study.Data were extracted from the medical records of patients and from hospital computerized databases or clinical charts according to a prepared questionnaire. The following data were reviewed: demographics, clinical and laboratory findings, comorbidity conditions (like diabetes mellitus, cardiovascular disease, pulmonary disease, renal disease, hepatic disease, central nervous...

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Section: Discussionsupporting

confidence: 88%

Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection

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Russo

Iraci

et al. 2016

Antimicrob Agents Chemother

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“…We retrieved 1069 non-duplicated citations for a review of their title and abstracts, and included 10 articles for meticulous evaluation after eliminating references based on our inclusion criteria ( Figure 1). We contacted the corresponding authors of three studies to request additional data [22][23][24] and received replies from the authors of two studies [22,24]. In addition, one study is a conference poster [23].…”

Section: Resultsmentioning

confidence: 99%

“…Characteristics of the studies included are summarized in Table 1. In total, the study included one randomized controlled trial [12] and three retrospective cohort studies [11,22,24]. One retrospective cohort study was designed to compare escalated vancomycin dose to 500 mg 4 times per day in patients who failed to respond to conventional dose of vancomycin.…”

Section: Resultsmentioning

confidence: 99%

Effective Dosage of Oral Vancomycin in Treatment for Initial Episode of Clostridioides difficile Infection: A Systematic Review and Meta-Analysis

et al. 2019

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Background: Oral vancomycin is a first line treatment for an initial episode of Clostridioides difficile infection. However, the comparative efficacy of different dosing regimens is lacking evidence in the current literature. Methods: We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. from inception to May 2019. Only articles published in English are reviewed. This meta-analysis compares the effects of low dose oral vancomycin (<2 g per day) versus high dose vancomycin (2 g per day) for treatment of initial Clostridioides difficile infection. Results: One randomized controlled trial and two retrospective cohort studies are included. A total of 137 patients are identified, 53 of which were treated with low dose oral vancomycin (39%) and 84 with high dose oral vancomycin (61%). There is no significant reduction in recurrence rates with high dose vancomycin compared to low dose vancomycin for treating initial episodes of non-fulminant Clostridioides difficile infection ((odds ratio (OR) 2.058, 95%, confidence interval (CI): 0.653 to 6.489). Conclusions: Based on limited data in the literature, low dose vancomycin is no different than high dose vancomycin for treatment of an initial episode of Clostridioides difficile infection in terms of recurrence rate. Additional large clinical trials comparing the different dosages of vancomycin in initial Clostridioides difficile infection are warranted.

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“…68 Vancomycin dose above 125 mg four times daily is not routinely recommended, recent reports suggesting no improvement in clinical cure, mortality or complications with increasing dose in severe disease. 69 Reports of high serum vancomycin levels with 500 mg four times day dosing have also been noted in patients. [70][71][72] Intravenous vancomycin therapy is not effective in CDI, however, colonic administration through an enema may be effective as an adjunctive therapy (uncertain dosing) if oral therapy is unable to be tolerated (500 mg in 100 mL normal saline, rectally 6 hourly).…”

Section: Dosing and Administrationmentioning

confidence: 98%

“…Hospital compounded oral solution is not inferior to commercially available vancomycin capsules . Vancomycin dose above 125 mg four times daily is not routinely recommended, recent reports suggesting no improvement in clinical cure, mortality or complications with increasing dose in severe disease . Reports of high serum vancomycin levels with 500 mg four times day dosing have also been noted in patients .…”

Section: What Antibiotics Should Be Used For Treatment Of An Initial mentioning

confidence: 99%

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

Trubiano

Cheng

Korman

et al. 2016

Internal Medicine Journal

136

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The incidence of Clostridium difficile infection (CDI) continues to rise, whilst treatment remains problematic due to recurrent, refractory and potentially severe nature of disease. The treatment of C. difficile is a challenge for community and hospital-based clinicians. With the advent of an expanding therapeutic arsenal against C. difficile since the last published Australasian guidelines, an update on CDI treatment recommendations for Australasian clinicians was required. On behalf of the Australasian Society of Infectious Diseases, we present the updated guidelines for the management of CDI in adults and children.

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Effect of vancomycin dose on treatment outcomes in severe Clostridium difficile infection

Cited by 27 publications

References 28 publications

Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection

Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection

Effective Dosage of Oral Vancomycin in Treatment for Initial Episode of Clostridioides difficile Infection: A Systematic Review and Meta-Analysis

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

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