Oral vancomycin prophylaxis for the prevention of Clostridium difficile infection: A systematic review and meta-analysis

Abstract

Objective: Recently, oral vancomycin prophylaxis (OVP) has been suggested for the prevention of Clostridium difficile infection (CDI). We conducted a systematic review and meta-analysis to investigate the efficacy and safety of this approach. Design: Systematic review and meta-analysis. Methods: We conducted a computerized search of MEDLINE, EMBASE, and Cochrane databases from inception to March 2019 for publications investigating OVP for CDI prevention. Results were screened for eligibility. Relevant data were extracted and analyzed. Publication bias was assessed using the Egger test. Results: Ultimately, 8 retrospective studies and 1 prospective study examining 2174 patients, published between 2016 and 2019 were included in the review. OVP was associated with decreased CDI (odds ratio, 0.263; 95% confidence interval, 0.13–0.52) with considerable heterogeneity (I2 = 61%). Meta-regression showed that total daily dose of OVP correlated with CDI, explaining 100% of heterogeneity between studies. Furthermore, 3 studies evaluated the risk of vancomycin-resistant enterococci (VRE) infection after OVP and found no significant increase. Conclusion: Our results suggest that OVP might decrease CDI rates in at-risk populations, although this conclusion should be interpreted with caution. Higher daily doses of OVP might increase CDI. Although the use of OVP in high-risk patients may reduce CDI, this suggestion has yet to be validated by prospective blinded randomized controlled trials.

Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

“…There are key differences between the present work and the two previous meta-analyses [ 44 , 45 ]. Babar and colleagues included fewer studies and, performing several meta-regression analyses, did not investigate the impact of OVP duration [ 44 ].…”

“…To the best of our knowledge, this is the first systematic review and meta-analysis with trial sequential analysis addressing the clinical question of the effectiveness of OVP in CDI prevention in persons undergoing SAT. Two earlier meta-analyses have been published on the topic [ 44 , 45 ] that informed a recent guideline endorsed by the American College of Gastroenterology (ACG) [ 46 ]. ACG experts conditionally recommend OVP for secondary CDI prevention in high-risk patients undergoing SAT, although the recommendation is supported by low-quality evidence [ 46 ].…”

Clostridioides difficile and Vancomycin-Resistant Enterococci in COVID-19 Patients with Severe Pneumonia

“…In those two retrospective studies, no CDI was detected in patients receiving OVP. Similarly, a meta-analysis by Babar et al [ 59 ] documented a reduction in CDI in high-risk patients following OVP administration. In their meta-analysis, Tariq et al [ 14 ] suggested a positive effect of vancomycin to prevent CDI recurrence (secondary prophylaxis).…”

Impact of Clostridioides difficile Therapy on Nosocomial Acquisition of Vancomycin-Resistant Enterococci

“…These results correspond with previous studies. Possible sources of bias in these studies are the analysis of VRE acquisition during CDI prophylaxis with vancomycin [22] and the gender distribution of a patient cohort with more than 90% of male individuals [12,23]. Nevertheless, available data surprisingly do not suggest any association between vancomycin administration and hospital-acquired VRE in CDI affected patients, whereby studies in non-CDI-patients have verified this association [23,24].…”