Department of Pharmacy, Montefiore Medical Center, The Bronx, New York
Departments of Pediatrics and.
Pediatrics. 2021 Aug;148(2). doi: 10.1542/peds.2020-031807.
Secondary oral vancomycin prophylaxis (OVP) has been used in adults with a history of infection (CDI) while receiving systemic antibiotics to prevent CDI recurrence. However, this practice has not been studied in pediatric patients. The objective of this study was to assess the utility of secondary OVP in pediatric patients with previous CDI who received subsequent antibiotic exposure.
A multicampus, retrospective cohort evaluation was conducted among patients aged ≤18 years with any history of clinical CDI and receiving systemic antibiotics in a subsequent encounter from 2013-2019. Patients who received concomitant OVP with antibiotics were compared with unexposed patients. The primary outcome was CDI recurrence within 8 weeks after antibiotic exposure. Infection with vancomycin-resistant enterococci and risk factors for CDI recurrence were assessed.
A total of 148 patients were screened, of which 30 and 44 patients received OVP and no OVP, respectively. Patients who received OVP had greater antibiotic use and hospital lengths of stay. The incidence of CDI recurrence within 8 weeks of antibiotic exposure was significantly lower in patients who received OVP (3% vs 25%; = .02) despite this group having notably more risk factors for recurrence. There were no vancomycin-resistant enterococci infections in any patients within either group. After adjustment in a multivariable analysis, secondary OVP was associated with less risk of recurrence (odds ratio, 0.10; 95% confidence interval, 0.01-0.86; = .04).
Secondary OVP while receiving systemic antibiotics reduces the risk of recurrent CDI in pediatric patients with a history of CDI.
在接受全身性抗生素治疗的感染（CDI）病史的成人中，二级口服万古霉素预防（OVP）已被用于预防 CDI 复发。然而，尚未在儿科患者中对此进行研究。本研究的目的是评估在接受后续抗生素暴露的既往 CDI 儿科患者中，二级 OVP 的实用性。
对 2013-2019 年间在任何有临床 CDI 病史且在后续就诊中接受全身性抗生素治疗的≤18 岁患者进行了多校区回顾性队列评估。将接受抗生素联合 OVP 的患者与未暴露的患者进行比较。主要结局是抗生素暴露后 8 周内 CDI 复发。评估了万古霉素耐药肠球菌感染和 CDI 复发的危险因素。
共筛选了 148 例患者，其中 30 例和 44 例患者分别接受了 OVP 和无 OVP。接受 OVP 的患者抗生素使用和住院时间更长。尽管接受 OVP 的患者具有更多的复发危险因素，但抗生素暴露后 8 周内 CDI 复发的发生率明显较低（3%对 25%； =.02）。两组均无万古霉素耐药肠球菌感染。在多变量分析中调整后，二级 OVP 与复发风险降低相关（比值比，0.10；95%置信区间，0.01-0.86； =.04）。
在接受全身性抗生素治疗的既往 CDI 儿科患者中，二级 OVP 可降低复发性 CDI 的风险。
