Examining Oral Vancomycin as a First-Line CDI Therapy

With limitations on fidaxomicin at their facility, a hospital looked at vancomycin usage to determine if they needed to align with the new IDSA/SHEA CDI treatment guideline.

Madeline Belk, PharmD, says that her institution, Huntsville Hospital in Huntsville, Alabama, has restricted prescribing privileges of fidaxomicin to the infectious disease (ID) and gastrointestinal (GI) providers only. And with the IDSA/SHEA C diff treatment guideline now recommending fidaxomicin for first-line therapy, Belk, et al decided to evaluate patients hospitalized with CDI who received treatment with oral vancomycin to determine outcomes and if they needed to shift to prescribing fidaxomicin. 

They performed a retrospective cohort study with adult patients hospitalized for CDI and who received vancomycin. These patients were analyzed between January 2020 and December 2020 and were excluded if they received additional CDI therapies or were receiving treatment prior to hospitalization.

“One-hundred and eighteen patients were included in the analysis. On average, patients were 66 years old, most were female (58%), hospital length of stay was 12 days, most had CDI severity of mild-moderate or severe, and average duration of treatment was 14 days,” the investigators wrote. “Only 3 of 118 (2.5%) experienced recurrent CDI at 60 days. Thirty-day readmissions occurred in 23 (19%) of patients with only 3 (3%) deemed to be related to CDI. Variables associated with increased likelihood of 30-day readmission included age 65 and older (OR 4.53, 95% CI 1.12–18.37; p=0.034) and higher CCI score (OR 1.40, 95% CI 1.04–1.89; p=0.025).”

The investigators concluded that using oral vancomycin as a first-line therapy had low rates of recurrence and CDI-related readmissions, and they decided to keep fidaxomicin with the GI and ID providers.

The study, “Characteristics of patients hospitalized with Clostridioides difficile infection and treated with vancomycin,” was presented at the 24th Annual Making a Difference in Infectious Disease (MAD-ID) Meeting 2022 in Orlando, Florida from May 18-21.

Contagion spoke to study coauthor Belk at the MAD-ID meeting who provided more information about the study’s findings.