University of Kansas Health System Cancer Pharmacy, The University of Kansas Health System, Kansas City, Missouri, USA.
Transpl Infect Dis. 2022 Apr;24(2):e13790. doi: 10.1111/tid.13790. Epub 2022 Jan 25.
Neutropenia and antibiotic use put patients at risk for Clostridioides difficile infection (CDI) following allogenic hematopoietic cell transplant (alloHCT). CDI following alloHCT has been associated with acute graft-versus-host disease (aGVHD), a significant cause of morbidity and mortality in this population. We sought to evaluate if prophylactic oral vancomycin reduces the incidence of CDI in alloHCT recipients.
We conducted a single-center retrospective chart review to compare the effectiveness of oral vancomycin prophylaxis versus no prophylaxis in alloHCT recipients at the University of Kansas Health System. Vancomycin for CDI prophylaxis was implemented in March of 2018 at the University of Kansas Health System. Review of 100 consecutive alloHCT patients before and after this implementation was used to compare outcomes. Patients received oral vancomycin 125 mg twice daily, starting on the day of inpatient admission for alloHCT and continued until discharge. The primary outcome is the incidence of CDI in patients with oral vancomycin prophylaxis compared to those who did not receive prophylaxis during hospital admission for alloHCT. The secondary endpoints include the incidence of acute grades 2-4 GVHD, and event-free survival for each arm.
Eleven percent of patients developed CDI in the control group versus 2% of patients in the intervention group (p = .018). Oral vancomycin was not associated with a higher risk of acute GVHD grades 2-4 (36% vs. 38%; p = .77) at day 100 post transplant. No difference was seen in event-free survival.
Oral vancomycin was associated with reduced CDI incidence in patients that underwent an alloHCT without negatively affecting posttransplant outcomes. The contribution of confounders cannot be excluded.
中性粒细胞减少症和抗生素的使用使异体造血细胞移植（alloHCT）后的患者有发生艰难梭菌感染（CDI）的风险。alloHCT 后发生 CDI 与急性移植物抗宿主病（aGVHD）有关，这是该人群发病率和死亡率的一个重要原因。我们试图评估预防性口服万古霉素是否能降低 alloHCT 受者中 CDI 的发生率。
我们进行了一项单中心回顾性图表审查，以比较堪萨斯大学卫生系统 alloHCT 受者中口服万古霉素预防与无预防的效果。堪萨斯大学卫生系统于 2018 年 3 月开始使用万古霉素预防 CDI。使用该方案实施前后的 100 例连续 alloHCT 患者进行回顾性比较。患者在 alloHCT 住院当天开始接受口服万古霉素 125mg，每日两次，持续至出院。主要结局是接受口服万古霉素预防的患者与 alloHCT 住院期间未接受预防的患者相比 CDI 的发生率。次要终点包括急性 2-4 级 GVHD 的发生率和每个治疗组的无事件生存。
对照组中有 11%的患者发生 CDI，而干预组中有 2%的患者发生 CDI（p=0.018）。在移植后 100 天，口服万古霉素与急性 2-4 级 GVHD 的风险增加无关（36%对 38%；p=0.77）。无事件生存也无差异。
口服万古霉素与降低 alloHCT 患者 CDI 发生率相关，而不会对移植后结局产生负面影响。不能排除混杂因素的影响。
