1/#ManuscriptMonday #IDTwitter #Tweetorial
Does oral vanco ppx during systemic abx therapy prevent healthcare facility-onset C. diff infection in high-risk patients?
@MannyGuajardoMD recently reviewed a study on this very topic at our virtual JC.
pubmed.ncbi.nlm.nih.gov/31560051
2/Healthcare facility-onset C diff infection (HCFO-CDI) is ️💰🤒☠️
What can we do to prevent HCFO-CDI?
✅Inf prevention strategies
✅#AntimicrobialStewardship
❓Probiotics
❓OVP
3/Downsides to OVP:
💊Affects GI microflora
💊VRE overgrowth 📈
💊Increased risk for C. diff colonization
💊Not always tolerated
💊Cost effective?
pubmed.ncbi.nlm.nih.gov/31560048/
4/This open-label, randomized, prospective study at a single US center identified admitted patients at high-risk for CDI via a computer-based risk-prediction model.
pubmed.ncbi.nlm.nih.gov/30318399/
High-risk:
👴>60yo
🏥Hosp ≤30d prior
💊Got systemic abx during prior admit
5/Inclusion criteria:
✅High risk for CDI
✅Currently on systemic abx
✅Admitted >72h
Exclusion criteria:
❌Active CDI
❌On probiotics
❌On metronidazole
❌Unable to take oral vanco
6/Treatment arms:
💊OVP while on systemic abx + 5d after (vanc 125mg daily)
💊No prophylaxis (NP)
60% of OVP had VRE swabs at baseline & discharge.
7/Primary endpoint = incidence of HCFO-CDI
Results?
💊OVP = 0/50
💊NP = 6/50 (p=0.03)
Average duration of OVP = 12d
NNT to prevent 1 episode of HCFO-CDI in these high-risk patients = 9
8/Other findings:
💊 OVP was tolerated ➡️ 1 person with mild GI upset
💊 No new VRE colonization with OVP
💊 OVP is cost-effective ➡️ $26/patient
9/Also, the OVP arm may have been at a higher risk for HCFO-CDI ➡️ received more high-risk antibiotics during prior and index hospitalizations
👇 refresher on which antibiotics are more "Cdiff-genic"
10/Overall, this is a positive study with some limitations (small, incomplete follow-up).
Will you be using #OVP for #Cdiff prevention in hospitalized patients receiving systemic antibiotics who are at high-risk for CDI?
@ID_fellows @IDSAMedEdCOP @SHEA_Epi
11/️Check out some other papers for a deeper dive into this topic ⬇️
DOI: 10.1093/jac/dkw383
DOI: 10.1093/cid/ciz966
DOI: 10.1017/ice.2020.277
And a must read for #IDFellows... tinyurl.com/yyzu6xsl
Share this Scrolly Tale with your friends.
A Scrolly Tale is a new way to read Twitter threads with a more visually immersive experience.
Discover more beautiful Scrolly Tales like this.