Efficacy of Oral Vancomycin in Preventing Recurrent<i>Clostridium difficile</i>Infection in Patients Treated With Systemic Antimicrobial Agents: Table 1.

Hise, Nicholas W. Van; Bryant, Alex; Hennessey, Erin; Crannage, Andrew J.; Khoury, Jad A.; Manian, Farrin A.

doi:10.1093/cid/ciw401

Cited by 88 publications

(79 citation statements)

References 9 publications

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“…46 Some data suggest that the empirical addition of oral vancomycin, at a dose of 125 mg or 250 mg twice/ day as secondary prophylaxis, may lower the relative risk of CDI recurrence by 50% or more for patients on systemic antimicrobial therapy. [47][48][49] However, these studies were limited by their retrospective design and inconsistent dosing strategies. Very little data exist regarding the use of fidaxomicin for CDI prophylaxis outside of patients who have undergone hematopoietic stem cell transplantation.…”

Section: Prophylaxismentioning

confidence: 99%

“…50 Due to the unproven benefits of empirical antibiotic prophylaxis against CDI, the SHEA/IDSA guideline acknowledged that although no prospective randomized trials exist, low-dose vancomycin (e.g., 125 mg once or twice/day) or fidaxomicin (200 mg once/day) could be considered in this situation. 11,47 Although secondary CDI prophylaxis may present in various clinical situations, the time from last CDI treatment, number of previous CDI episodes, and underlying frailty of the patient are suggested factors to consider when evaluating whether to administer secondary prophylaxis. 11…”

Section: Prophylaxismentioning

confidence: 99%

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Prevention of Clostridium difficile Infection in Critically Ill Adults

et al. 2019

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The incidence and severity of Clostridium difficile infection (CDI) remain high across intensive care units in the United States despite national efforts to decrease this escalating health care burden. Most published literature and guidelines address treatment rather than prevention, yet this approach may be too downstream to limit morbidity and mortality from the disease and its complications. Mechanisms to prevent CDI successfully include reducing modifiable risk factors and minimizing horizontal transmission of C. difficile spores between patients and the health care environment. Because CDI prevention is characterized by a bundled approach, it is difficult to quantify the individual impact of any one element; however, a number of patient‐ and facility‐level strategies can be considered for CDI prevention. Robust hygiene strategies, diagnostic and antimicrobial stewardship, and particular prophylaxis maneuvers such as continuation of oral vancomycin or fidaxomicin in the setting of systemic antibiotics have all demonstrated benefit. The preventive roles of deprescribing acid suppressants, routine use of probiotics, or early fecal microbiota transplantation remain unclear. The focus of this review is to summarize the evidence related to primary and secondary CDI prevention in critically ill adults and provide a concise implementation pathway for clinicians and policymakers.

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Section: Prophylaxismentioning

confidence: 99%

Section: Prophylaxismentioning

confidence: 99%

Prevention of Clostridium difficile Infection in Critically Ill Adults

et al. 2019

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“…Patients currently or recently treated for CDI may require additional antimicrobial therapy for a concomitant infection. Recently, two retrospective cohort studies have specifically addressed the use of vancomycin to prevent CDI recurrence in patients treated with systemic antimicrobials for another infection (121,122). While both were limited by several biases, they still add interesting information about the potential use of vancomycin as a prophylactic agent.…”

Section: Antimicrobialsmentioning

confidence: 99%

Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection

Loo

Davis

Embil

et al. 2018

Official Journal of the Association of Medical Microbiology and

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Clostridium difficile is recognized as a major cause of infection in health care facilities, associated with substantial morbidity and mortality, prolonged length of hospital stay, and excess costs. The frequency and severity of CDI increased dramatically in North America and in many parts of Europe approximately 15 years ago, with the emergence of a hyper-virulent strain of C. difficile, designated based on various strain typing methods as either AMMI CANADA GUIDELINE

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“…Although not studied specifically in patients with liver failure, a retrospective cohort study demonstrated a significant reduction in CDI with oral vancomycin prophylaxis (4.2 vs. 26.6% in patients with vs. without prophylaxis). 97 Fulminant CDI presents with hypotension, shock, ileus, or megacolon; ileus can present with little to no diarrhea. 91 These patients should be treated with IV metronidazole in addition to vancomycin orally, through nasogastric tube, or per rectum.…”

Section: Clostridioides Difficile Infectionmentioning

confidence: 99%

Infectious Complications in Critically Ill Liver Failure Patients

Cheung

Tanna

Ison

2018

Semin Respir Crit Care Med

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Infections remain a leading cause of morbidity and mortality among patients with liver failure. A number of factors, including relative immune dysfunction and systemic inflammation, bacterial translocation, gut dysbiosis, small intestine bacterial overgrowth, altered bile acid pools, and changes in pH due to acid suppression, contribute to the high rates of infection in this population. Though a range of infections can complicate the course of cirrhotic patients, spontaneous bacterial peritonitis (SBP), cholangitis, and cholecystitis in addition to other infections (i.e. pneumonia, urinary tract infection, bacteremia, and Clostridioides difficile colitis) are more common in this population and will be reviewed in this article. Preventative strategies are directed at minimizing the risk of SBP through the use of targeted antimicrobial prophylaxis. Lastly, the critically ill cirrhotic patient may present with an acute need for liver transplantation. Thus, careful assessment for ongoing infection should be performed and treated to optimize outcomes of transplant, if needed.

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Efficacy of Oral Vancomycin in Preventing RecurrentClostridium difficileInfection in Patients Treated With Systemic Antimicrobial Agents: Table 1.

Cited by 88 publications

References 9 publications

Prevention of Clostridium difficile Infection in Critically Ill Adults

Prevention of Clostridium difficile Infection in Critically Ill Adults

Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection

Infectious Complications in Critically Ill Liver Failure Patients

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