Williams Michael J, Atienza Sol, Franzen Erin, Rathod Heena, Mejaki Brittany, Graff Justin, Korman Sandra, Zouine Noah, Gul Zartash, Sana Sherjeel, Medlin Stephen, Buggy Brian P
Malignant Hematology and Stem Cell Transplant, Aurora St Luke's Medical Center, Milwaukee, Wisconsin, USA.
Department of Pharmacy, Aurora St Luke's Medical Center, Milwaukee, Wisconsin, USA.
Open Forum Infect Dis. 2024 Oct 14;11(11):ofae622. doi: 10.1093/ofid/ofae622. eCollection 2024 Nov.
Evaluations of oral vancomycin prophylaxis (OVP) against have been reported in stem cell transplant populations with short follow-up periods. The longest known duration of standardized follow-up post-OVP is 90 days within an allogeneic stem cell transplant population. In 2017, we implemented OVP 125 mg twice daily in autologous stem cell transplant (ASCT) recipients beginning the day of admission and continued until the day of discharge.
Patients who received an ASCT within our institution between 1 January 2012 and 31 December 2021 were included and separated into 2 groups based on the receipt of OVP. The primary study aim was to measure the incidence of infection (CDI) during the ASCT admission. A secondary aim was to evaluate for delayed CDI 180 days post-discharge. Other factors evaluated were prior history of CDI, use of systemic antimicrobials, and length of stay.
Overall, 254 patients were evaluated and 58% received OVP, predominantly as primary prophylaxis (95%). Of the 18 patients who developed in-hospital CDI, 6 were in the OVP group versus 12 in the non-OVP cohort (4% vs 11%, = .03). In the 180-day follow-up period, OVP use did not increase risk of developing CDI after discontinuation while in-hospital length of stay was identified as a significant factor.
The use of OVP significantly reduced the incidence of CDI during the in-hospital ASCT course without increasing CDI post-OVP use. These encouraging results should promote further research into the use of OVP in ASCT.
在干细胞移植人群中，已报告了针对[具体疾病未提及]的口服万古霉素预防（OVP）的评估，但随访期较短。在异基因干细胞移植人群中，已知的OVP标准化随访最长持续时间为90天。2017年，我们在自体干细胞移植（ASCT）受者中从入院当天开始实施每日两次125毫克的OVP，并持续至出院当天。
纳入2012年1月1日至2021年12月31日在本机构接受ASCT的患者，并根据是否接受OVP分为两组。主要研究目的是测量ASCT住院期间[具体疾病未提及]感染（CDI）的发生率。次要目的是评估出院后180天的延迟CDI。评估的其他因素包括既往CDI病史、全身抗菌药物的使用和住院时间。
总体而言，共评估了254例患者，58%接受了OVP，主要作为一级预防（95%）。在18例发生院内CDI的患者中，6例在OVP组，12例在非OVP队列（4%对11%，P = 0.03）。在为期180天的随访期内，使用OVP并未增加停药后发生CDI的风险，而住院时间被确定为一个重要因素。
使用OVP显著降低了ASCT住院期间CDI的发生率，且未增加使用OVP后CDI的发生率。这些令人鼓舞的结果应推动对OVP在ASCT中应用的进一步研究。
