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

Maraolo, Alberto Enrico; Mazzitelli, Maria; Zappulo, Emanuela; Scotto, Riccardo; Granata, Guido; Andini, Roberto; Durante‐Mangoni, Emanuele; Petrosillo, Nicola; Gentile, Ivan

doi:10.3390/antibiotics11020183

Cited by 22 publications

(19 citation statements)

References 70 publications

(163 reference statements)

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“…A meta-analysis of three retrospective cohort studies and one randomized, open-label study evaluated the effectiveness of vancomycin as a prophylaxis [ 22 ]. Two of the studies consisted of patients receiving transplants, and the other two included older adults who were receiving systemic antibiotics.…”

Section: Primary Preventionmentioning

confidence: 99%

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Controversies in the Prevention and Treatment of Clostridioides difficile Infection in Adults: A Narrative Review

et al. 2023

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Clostridioides difficile remains a problematic pathogen resulting in significant morbidity and mortality, especially for high-risk groups that include immunocompromised patients. Both the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America (IDSA/SHEA), as well as the American College of Gastroenterology (ACG) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) recently provided guideline updates for C. difficile infection (CDI). In this narrative review, the authors reviewed available literature regarding the prevention or treatment of CDI in adults and focused on disagreements between the IDSA/SHEA and ACG guidelines, as well as articles that have been published since the updates. Several options for primary prophylaxis are available, including probiotics and antibiotics (vancomycin, fidaxomicin). The literature supporting fidaxomicin is currently quite limited. While there are more studies evaluating probiotics and vancomycin, the optimal patient populations and regimens for their use have yet to be defined. While the IDSA/SHEA guidelines discourage metronidazole use for mild CDI episodes, evidence exists that it may remain a reasonable option for these patients. Fidaxomicin has an advantage over vancomycin in reducing recurrences, but its use is limited by cost. Despite this, recent studies suggest fidaxomicin’s cost-effectiveness as a first-line therapy, though this is highly dependent on institutional contracts and payment structures. Secondary prophylaxis should focus on non-antimicrobial options to lessen the impact on the microbiome. The oral option of fecal microbiota transplantation (FMT), SER109, and the now FDA-approved RBX2660 represent exciting new options to correct dysbiosis. Bezlotoxumab is another attractive option to prevent recurrences. Further head-to-head studies of newer agents will be needed to guide selection of the optimal therapies for CDI primary and secondary prophylaxis.

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Section: Primary Preventionmentioning

confidence: 99%

“…The aforementioned meta-analysis also evaluated the effectiveness of vancomycin as a secondary prophylaxis for CDI [ 22 ]. Seven retrospective cohort studies were included in the analysis.…”

Section: Secondary Preventionmentioning

confidence: 99%

Controversies in the Prevention and Treatment of Clostridioides difficile Infection in Adults: A Narrative Review

et al. 2023

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“…CDI antibiotic prophylaxis for certain very high-risk patients who are receiving systemic antibiotics: a. Recent systematic reviews and meta-analyses 149,150 are conflicted about the benefit of oral vancomycin prophylaxis for the primary prevention of CDI. b.…”

Section: Use Of Probiotics As Primary Prophylaxismentioning

confidence: 99%

Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update

Kociolek

Gerding

Carrico

et al. 2023

Infect. Control Hosp. Epidemiol.

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Table 1. Summary of Recommendations to Prevent Clostridioides difficile Infection (CDI) Essential Practices 1. Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program. (Quality of evidence: MODERATE) a. Ensure appropriate use of antimicrobials for CDI treatment. b. Ensure appropriate use of non-CDI-treatment antimicrobials. 2. Implement diagnostic stewardship practices for ensuring appropriate use and interpretation of C. difficile testing. (Quality of evidence: LOW) a. Hospital infection prevention and control programs should work with their clinical microbiology laboratory to develop pre-agreed criteria for C. difficile testing, particularly if NAATs are used either as a standalone test or part of a multi-step testing algorithm. b. At minimum, C. difficile testing should be avoided in patients without clinically significant diarrhea, in those who have been tested in the prior 7 days, and in children aged <1 year. c. Ordering providers and bedside nurses should receive education about appropriate use and interpretation of C. difficile testing. d. If feasible, the electronic medical record system should be leveraged to provide computerized provider order entry support and/or monitoring for clinical testing criteria. 3. Use contact precautions for infected patients, single-patient room preferred. (Quality of evidence: LOW for hand hygiene; MODERATE for gloves; LOW for gowns; LOW for single-patient room) a. Perform hand hygiene based on CDC or WHO guidelines before and after entering the room (ie, immediately before donning and after removing personal protective equipment). b. Place patients with CDI on contact precautions to help reduce patient-to-patient spread of the organism. c. Cohorting of patients with CDI is acceptable when single private rooms are not available. d. Ensure that adequate supplies for contact precautions are readily available. e. Follow appropriate criteria for discontinuing contact precautions.4. Adequately clean and disinfect equipment and the environment of patients with CDI. (Quality of evidence: LOW for equipment; LOW for environment) a. C. difficile spores contaminate the environment in which patients are housed and the equipment used to care for them. b. Contaminated surfaces and equipment are potential reservoirs for transmission of C. difficile. c. Develop and implement protocols for disinfection of equipment and the environment. d. Dedicate noncritical patient care items, such as blood pressure cuffs, stethoscopes, and thermometers, to a single patient with C. difficile. 5. Assess the adequacy of room cleaning. (Quality of evidence: LOW) a. Work with the environmental services team to establish a process for assessing adequacy of room cleaning at a frequency that is feasible for the team.b. The process should focus on reviewing and improving cleaning/disinfection techniques. Important issues to address include proper dilution of cleaning/disinfection products, adequacy of cleaning/disinfection technique, cleaning "high-touch" surfac...

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“…Maraolo и соавт. (2022) включил 929 пациентов, получавших системную антибиотикотерапию и имевших высокий риск КДИ, которым была назначена пероральная профилактика КДИ ванкомицином, и 2011 человек представляли группу сравнения (без активной профилактики) [58]. Анализ подтвердил сильный защитный эффект в отношении возникновения КДИ: ОШ 0,14, 95% ДИ 0,04-0,38.…”

Section: степ-терапия ванкомицином при рецидивах Clostridioides Diffi...unclassified

<i>Clostridioides difficile</i> – a new name, the old problems with diagnosis and treatment

Захаренко¹

2023

Almanac of Clinical Medicine

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Clostridium difficile was reclassified in 2016 under a new name of Clostridioides difficile. In 2021 to 2022, some changes were implemented into the main clinical guidelines on the diagnosis and treatment of infections caused by this pathogen. A two-step algorithm based on identification of C. difficile and then its toxins is still recommended for the diagnosis. The treatment regimens for the first episode and relapses of C. difficile-associated infection are based on metronidazole, vancomycin and fidaxomycin. Additional effectiveness of therapy has been associated with the use of microbiocenosis-oriented technologies aimed at restoration of the colon microbiota. In the Russian Federation, all widely applied diagnostic methods are available and all recommended antimicrobials, except fidaxomycin, as well as bezlotoxumab and fecal microbiota transplantation.

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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

Cited by 22 publications

References 70 publications

Controversies in the Prevention and Treatment of Clostridioides difficile Infection in Adults: A Narrative Review

Controversies in the Prevention and Treatment of Clostridioides difficile Infection in Adults: A Narrative Review

Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update

<i>Clostridioides difficile</i> – a new name, the old problems with diagnosis and treatment

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