Thread by @BCMIDFellowship

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