Study examines effect of low-dose vancomycin to treat clostridium difficile infection

Clostridium difficile infection (CDI) is inflammation of the colon caused by a bacteria called clostridium difficile and is the most common cause of infectious diarrhea in hospitalized patients.

Blood and marrow transplant (BMT) patients appear to be one of the most vulnerable populations to develop CDI due to previous antimicrobial exposure and prolonged hospitalizations.

In a retrospective review, members of the Hematologic Malignancies Program at Rutgers Cancer Institute of New Jersey examined the utilization of a low dose of oral vancomycin, a drug used at higher doses to treat established CDI, as a way to prevent CDI in these patients and found the drug to be the first and only intervention that helped decrease CDI rates in a five-year period.

Results of the study are being presented at the virtual American Society of Hematology Annual Meeting later this week. Senior author Dennis Cooper, MD, chief of Blood and Marrow Transplantation at Rutgers Cancer Institute and professor of medicine at Rutgers Robert Wood Johnson Medical School, shares more about the work:

Why is this topic important to explore?

Clostridium difficile is the most common cause of infectious diarrhea in hospitalized patients and these infections have important implications for patient morbidity and mortality, length of stay, and cost of therapy.

Tell us about the work and what you and your colleagues found?

Clostridium difficile infections are a nationwide problem and have been for a number of years. Although a number of strategies have modestly impacted the incidence of CDI in the hospital, we have had little or no success with BMT patients despite higher compliance of handwashing than anywhere in the hospital.

This is probably because of the weakened immune status of BMT patients as well as the fact that BMT patients often have to take medications that place them at greater risk for infection.

We found that a simple and inexpensive approach of administering prophylactic oral vancomycin – first initiated in December 2019 – has dramatically reduced the incidence of CDI without any obvious deleterious effects as of yet.

We saw an 83 percent decrease of CDI in the blood and marrow/leukemic population in the first eleven months of 2020, as compared to the same time period in 2019, and no CDI in allogeneic transplant patients – the most vulnerable population.

More time is needed to evaluate the effects of this approach within our program, but this is the first and only intervention that has helped to decrease the CDI rates in oncology in five years.

What are the implications and next steps related to this work?

At present, we continue to give all autologous and allogeneic transplant patients prophylactic oral vancomycin. Based on our findings, we believe that consideration should be given to extending this prevention strategy to leukemia patients and possibly solid organ transplant patients.

In addition, I believe that many institutions will be interested in either further testing or adopting this strategy.

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