How to: prophylactic interventions for prevention of Clostridioides difficile infection

Reigadas, Elena; Prehn, Joffrey van; Falcone, Marco; Fitzpatrick, Fidelma; Vehreschild, Maria J.G.T.; Kuijper, Ed J.; Bouza, Emilio; interaction, Microbiota

doi:10.1016/j.cmi.2021.06.037

Cited by 21 publications

(11 citation statements)

References 59 publications

(59 reference statements)

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“…Several strategies have been attempted to prevent primary and rCDI. These can be divided into five major categories: active immunization, passive immunization, dysbiosis restoration, dysbiosis prevention and antibiotic prophylaxis [ 8 ]. The present work is aimed at evaluating, by systematically reviewing available data from the literature and through appropriate meta-analytic techniques including trial sequential analysis (TSA), the role of oral vancomycin prophylaxis (OVP) for primary and secondary prevention of CDI in subjects undergoing systemic antibiotic therapy (SAT).…”

Section: Introductionmentioning

confidence: 99%

Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

et al. 2022

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Background: Clostridioides difficile infection (CDI) is associated with substantial morbidity and mortality as well as high propensity of recurrence. Systemic antibiotic therapy (SAT) represents the top inciting factor of CDI, both primary and recurrent (rCDI). Among the many strategies aimed to prevent CDI in high-risk subjects undergoing SAT, oral vancomycin prophylaxis (OVP) appears promising under a cost-effectiveness perspective. Methods: A systematic review with meta-analysis and trial sequential analysis (TSA) of studies assessing the efficacy and the safety of OVP to prevent primary CDI and rCDI in persons undergoing SAT was carried out. PubMed and EMBASE were searched until 30 September 2021. The protocol was pre-registered on PROSPERO (CRD42019145543). Results: Eleven studies met the inclusion criteria, only one being a randomized controlled trial (RCT). Overall, 929 subjects received OVP and 2011 represented the comparator group (no active prophylaxis). OVP exerted a strong protective effect for CDI occurrence: odds ratio 0.14, 95% confidence interval 0.04–0.38. Moderate heterogeneity was observed: I2 54%. This effect was confirmed throughout several subgroup analyses, including prevention of primary CDI versus rCDI. TSA results pointed at the conclusive nature of the evidence. Results were robust to a variety of sensitivity and quantitative bias analyses, although the underlying evidence was deemed as low quality. No differences between the two groups were highlighted regarding the onset of vancomycin-resistant Enterococcus infections. Conclusions: OVP appears to be an efficacious option for prevention of CDI in high-risk subjects undergoing SAT. Nevertheless, additional data from RCTs are needed to establish OVP as good clinical practice and define optimal dosage and duration.

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Section: Introductionmentioning

confidence: 99%

Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

et al. 2022

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“…La CDI es una infección con una tasa elevada de recurrencias (15-20%) que se producen tras los tratamientos antibacterianos (Vancomicina, Fidaxomicina, Metrinidazol) por persistencia de las esporas de estos microorganismos que vuelven a germinar [30][31][32][33].…”

Section: Infección Por Clostridioides Difficile (Cdi)unclassified

Infección Nosocomial: situación en España

Bouza

2023

RIECS

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Las infecciones Relacionadas con la Asistencia Sanitaria (IRAS) afectan a un 5-10% de todos los hospitalizados, cifras que con frecuencia no incluyen las adquiridas fuera del medio hospitalario pero en relación con procedimientos para el cuidado de la salud. Las más importantes son la Infección Urinaria relacionada con el catéter urinario (CAUTI), la bacteriemia nosocomial, habitualmente causada por infección de catéteres endovasculares, la infección respiratoria, la de piel y tejidos blandos, encabezada por la infección del sitio quirúrgico y la diarrea asociada a C. difficile. Los microorganismos causantes van desde los virus a los parásitos pero son las bacterias y en segundo lugar los hongos los más frecuentemente causales de infección nosocomial. La resistencia a antimicrobianos de muchos de estos agentes es un motivo más de preocupación. La pandemia de COVID-19 ha venido a deteriorar las medidas de control de las infecciones nosocomiales y a deteriorar sus cifras. España, según datos del estudio EPINE, tiene cifras de IRAS que podemos considerar aceptables pero que testimonian que no hemos mejorado en los últimos 10 años. Finalmente, y pese a las dificultades de cuantificarlo, el coste económico de estas infecciones es astronómico y puede estimarse para nuestro País por encima d ellos 1.000 millones de euros

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“…To our knowledge, there are no ongoing further studies, Valneva is searching for partners. Another vaccine developed by GlaxoSmithKline is currently in Phase I, targeting the F2 antigen of C. difficile [ 71 ].…”

Section: Overview Of Potential Vaccines Against Bacterial and Fungal ...mentioning

confidence: 99%

Vaccines for healthcare associated infections without vaccine prevention to date

et al. 2022

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How to: prophylactic interventions for prevention of Clostridioides difficile infection

Cited by 21 publications

References 59 publications

Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

Infección Nosocomial: situación en España

Vaccines for healthcare associated infections without vaccine prevention to date

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