Late Breaking Original Research
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction:
Clostridioides difficile infection (CDI) commonly causes healthcare-associated diarrhea that leads to increased costs and mortality. Recurrence is common and increases mortality. Recent CDI management guidelines suggest oral vancomycin prophylaxis (OVP) in high-risk patients without dosing recommendations. OVP 125mg once or twice daily are commonly ordered regimens. Minimal literature suggests that a twice-daily regimen may adversely affect recurrence rate, and OVP is costly for many patients. Clarifying the effects of OVP dosing strategy on patient-centered outcomes can further optimize CDI management and potentially reduce healthcare costs.
Research Question or Hypothesis: To compare rate of CDI recurrence with vancomycin vs twice daily
Study Design: Retrospective cohort study
Methods: Adult patients admitted from January 1, 2021 to August 3, 2023 who received OVP 125mg once or twice daily and systemic antibiotics were included. The primary outcome was rate of CDI recurrence, defined as a positive C. difficile toxin or treatment initiation within 90 days of OVP completion. Secondary outcomes were length of stay and 30-day mortality. Outcomes were modeled using logistic or linear regression.
Results: A total of 180 patients met inclusion criteria, while 46 patients were excluded primarily due to vancomycin taper. Of 133 remaining patients, 19 and 114 received once- and twice-daily OVP, respectively. Baseline characteristics were similar in both arms, but the once-daily group was more severely ill. Recurrence rate in the twice-daily group was not significantly different compared to the once-daily group (OR = 0.64 [0.06 – 6.95]). Our study also did not demonstrate a significant difference in 30-day mortality (OR = 2.83 [0.27 – 30.17]) or length of stay (OR = 3.67 [0.02 – 673.05]).
Conclusion: The recurrence rate was similar using OVP once vs twice daily. Mortality and length of stay were also similar. Future investigation is warranted with a larger sample size.
Presenting Author
Spencer Harris PharmDMidwestern University - Glendale Campus
Authors
Vanthida Huang Pharm.D., BSPHM, FCCP
Midwestern University, College of Pharmacy-Glendale