engleski

Efficacy of oral vancomycin in primary prevention of Clostridium difficile infection in elderly patients treated with systemic antibiotic therapy

Background: Clostridium difficile infection (CDI) is the leading cause of infectious healthcareassociated diarrhea. Although recent reports suggested that oral vancomycin might be an effective strategy for secondary prophylaxis of CDI recurrence in patients treated with systemic antibiotics, the efficacy of primary oral vancomycin prophylaxis (OVP) remains controversial and uninvestigated. While there is concern that OVP might have an impact on gut microbiome and facilitate colonization with nosocomial pathogens, new CDI preventive strategies are urgently needed especially in elderly population that experiences greatest morbidity and mortality. The question remains if potential benefits of primary OVP outweigh associated risks in this age group. The aim of this study was to determine whether OVP reduces the risk of CDI in hospitalized elderly patients treated with systemic antibiotics. Material/methods: A retrospective, cohort study included patients ≥65 years that were treated with antimicrobial therapy ≥24 hours and hospitalized ≥72 hours at the infectious disease ward in a 12- month period. Excluded were patients that were diagnosed with CDI within the first 48 hours of hospitalization. OVP group received ≥1 dose of vancomycin 125 mg once per day. Results: 170 patients were included in the study ; 49 in OVP (74.16±6.84 years ; 29 males) and 121 in control group (78.25±7.50 years ; 67 males). The patients in OVP group had higher age adjusted Charlson comorbidity index than controls (8.22±3.53 vs. 6.69±3.02, p=0.005). The majority of patients in both groups were diagnosed with urinary tract, skin/soft tissue, or respiratory infection ; sepsis was more frequently diagnosed in OVP group (40.82% vs. 22.31%, p=0.0223). There were no differences with regards to previous hospital admission within 3 months (26.53% vs. 33.88%), antibiotic therapy within 3 months (26.53% vs. 33.88%), PPI/H2RA treatment (24.49% vs. 22.31%), number of antibiotic classes used per patient or antibiotic prescription, except for cephalosporins that were more frequently prescribed in control group (18.37% vs. 43.80%, p=0.0016). The mean duration of antibiotic therapy in OVP group was longer (18.58±15.19 days vs 11.50±7.71 days, p=0.001), and nasogastric tube feeding more frequent (36.73% vs 20.66%. p=0.0337). None of the patients within OVP group developed in-hospital CDI. Meanwhile, 14 control patients developed in-hospital CDI (0% vs 11.57%, p=0.0001). None of the patients had nosocomial VRE infection ; 16 patients (13.22%) in control and 2 (4.08%) in OVP group had nosocomial infections caused by Enterobacteriaceae (p=0.1007). Conclusions: Primary OVP may be effective in reducing the risk of in-hospital CDI in elderly patients treated with systemic antimicrobial therapy. Prospective studies with follow-up are needed to define long-term efficacy and potential risks of this strategy

Vancomycin, Clostridium difficile infection, elderly patients, , antibiotic, therapy

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