Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee.
Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan.
Infect Control Hosp Epidemiol. 2020 Nov;41(11):1302-1309. doi: 10.1017/ice.2020.277. Epub 2020 Jun 29.
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.
Systematic review and meta-analysis.
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.
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.
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.
最近，口服万古霉素预防（OVP）被建议用于预防艰难梭菌感染（CDI）。我们进行了系统评价和荟萃分析，以调查这种方法的疗效和安全性。
系统评价和荟萃分析。
我们从 2019 年 3 月起对 MEDLINE、EMBASE 和 Cochrane 数据库进行了计算机检索，以检索研究 OVP 预防 CDI 的出版物。对结果进行了筛选，以确定其是否符合纳入标准。提取并分析了相关数据。使用 Egger 检验评估发表偏倚。
最终，有 8 项回顾性研究和 1 项前瞻性研究纳入了 2174 名患者，这些研究发表于 2016 年至 2019 年期间。OVP 与 CDI 降低相关（优势比，0.263；95%置信区间，0.13-0.52），且存在较大的异质性（I2=61%）。Meta 回归表明，OVP 的总日剂量与 CDI 相关，解释了研究之间 100%的异质性。此外，3 项研究评估了 OVP 后万古霉素耐药肠球菌（VRE）感染的风险，未发现显著增加。
我们的结果表明，OVP 可能降低高危人群的 CDI 发生率，但这一结论应谨慎解释。OVP 的日剂量越高，CDI 的发生率可能越高。虽然在高危患者中使用 OVP 可能会降低 CDI，但这一建议尚未通过前瞻性、双盲、随机对照试验得到验证。
