Impact of Clostridioides difficile length of treatment on rates of recurrence in patients on concurrent antibiotics

Rajakumar, Irina; Jaber, Rami H.; Ali, Raafi; Rennert-May, Elissa; Sabuda, Deana

doi:10.1016/j.ajic.2023.04.167

Cited by 1 publication

(8 citation statements)

References 14 publications

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“…In our study, only 36% of patients received CDI therapy for ≤14 days, which is similar to prior studies reporting that only 43%-47% of hospitalized patients received a standard treatment duration when also receiving concomitant antibiotics. [14][15][16] The median duration of vancomycin treatment in patients who had therapy prolonged was 20 days (IQR, [16][17][18][19][20][21][22][23][24][25][26], which is comparable to previously reported extended durations of 24-26 days. 14,15 Given the lack of available literature and treatment guidance from the IDSA for this population, we hypothesized reasons that clinicians may opt to prolong vancomycin treatment for CDI.…”

Section: Discussionsupporting

confidence: 60%

“…[14][15][16] The median duration of vancomycin treatment in patients who had therapy prolonged was 20 days (IQR, [16][17][18][19][20][21][22][23][24][25][26], which is comparable to previously reported extended durations of 24-26 days. 14,15 Given the lack of available literature and treatment guidance from the IDSA for this population, we hypothesized reasons that clinicians may opt to prolong vancomycin treatment for CDI. We detected notable differences between patients who received vancomycin for a standard versus a prolonged duration that may have affected prescribing decisions.…”

Section: Discussionsupporting

confidence: 60%

“…Vancomycin was discontinued prior to antibiotics in 15 patients (7%), on the same day as antibiotics in 20 patients (9%), and after antibiotics in 183 patients (84%). Among patients who had vancomycin continued beyond antibiotic completion, most patients continued treatment dose (147 of 183, 80%) for a median of 6 days (IQR, 5-14) or prophylactic dose (30 of 183, 16%) for a median of 6 days (IQR, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Resultsmentioning

confidence: 99%

“…Our recurrence rates were lower than published studies evaluating patients with CDI requiring concomitant antibiotics, with rates reported to be 21% within 8 weeks and 16%-29% within 6 months. [14][15][16] There may be several reasons for this difference. Oral metronidazole was used for CDI in 30%-70% of patients included in prior studies, which has been demonstrated to be inferior to vancomycin for CDI in terms of clinical cure and recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…However, these studies were limited by prevalent use of oral metronidazole as primary treatment for CDI, lack of description of CDI disease severity, and short duration of follow-up or loss to follow-up. [14][15][16] Because CDI practice guidelines do not address duration of oral vancomycin treatment with concomitant systemic antibiotics that cannot be discontinued, vancomycin prescribing varies in this clinical scenario. It is unclear whether prolonging the duration of vancomycin in a high-risk cohort of hospitalized patients reduces the risk of disease recurrence.…”

mentioning

confidence: 99%

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Impact of oral vancomycin treatment duration on rate of Clostridioides difficile recurrence in patients requiring concurrent systemic antibiotics

Kwiatkowski,

Marsh,

Katz

et al. 2024

Infect. Control Hosp. Epidemiol.

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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.

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