Oral Vancomyin for Primary Clostridium Difficile Infection Prophylaxis in Patients Receiving High-Risk Antibiotics
Oral Vancomyin for Primary Clostridium Difficile Infection Prophylaxis in Patients Receiving High-Risk Antibiotics
The purpose of this study is to determine if oral vancomycin used as primary Clostridium
 difficile prophylaxis can reduce the incidence of this infection in high-risk patients.
Clostridium difficile infection is a common healthcare-associated infection and one that is
 associated with significant morbidity as well as a risk for mortality. Current practice
 throughout the United States is targeted at infection prevention measures such as hand
 washing and isolation. Despite these measures, incidence of Clostridium difficile infections
 continue to rise as some institutions, including our own. Recently, a study published in
 Clinical Infectious Diseases found oral vancomycin for secondary prophylaxis to reduce the
 incidence of recurrence. No studies to date have evaluated primary prophylaxis with oral
 vancomycin. This will be a single center, prospective study to evaluate oral vancomycin use
 as primary Clostridium difficile prophylaxis. Patients treated by infectious disease
 physicians will be identified as "high risk" and after pager notification the ID physician
 will have the option to start oral vancomycin 125 mg by mouth daily if they determine it to
 be appropriate. Risk factors include age older than 65 years, taking gastric acid suppression
 medication, and receiving select broad-spectrum antibiotics. Oral vancomycin will be
 continued until de-escalation of antibiotics or hospital discharge and patients will be
 evaluated for Clostridium difficile infection development from the current hospital admission
 up to 4 weeks following antibiotic discontinuation.
Inclusion Criteria:

 -  "High-risk" patients defined as: age older than 65, on gastric acid suppression, and
 select antibiotics

 -  Gastric acid suppression includes proton pump inhibitors and histamine-2 receptor
 antagonists

 -  Selected antibiotics include fluoroquinolone (ciprofloxacin, levofloxacin),
 clindamycin, a 3rd or 4th generation cephalosporin, a broad-spectrum aminopenicillin
 (ampicillin-sulbactam, piperacillin-tazobactam), or a carbapenem

 Exclusion Criteria:

 -  Failure to meet all three requirements for "high risk"

 -  Vancomycin allergy

 -  Active clostridium difficile infection prior to inclusion

 -  Prophylactic oral vancomycin prior to study inclusion (i.e. prolonged vancomycin
 taper)

 -  Receipt of medications that also treat Clostridium difficile (metronidazole,
 rifaximin, fidaxomicin)

 -  Pregnant or breastfeeding