Purpose: Clostridium difficile infection (CDI) is higher in solid organ transplant recipients. IDSA/SHEA guidelines do not recommend prophylactic (PROPH) vancomycin (VANC) or metronidazole in CDI high risk patients or patients receiving antibiotics. Still, CDI PROPH is used at our institution. This study retrospectively reviews the impact of PROPH oral (PO) VANC on the prevention of recurrent CDI in renal transplant recipients (RTX) on antimicrobial therapy.

Methods: Adult renal transplant patients hospitalized during a unit-specific CDI outbreak, 1/1/2008-12/31/2013, were divided into matched cohort groups; those who received PROPH PO VANC 125 mg twice daily during and/or after receiving broad spectrum antibiotics (BSA) (cohort A, n=9) and those who did not receive PROPH VANC (cohort B, n=61). The primary outcome was CDI recurrence, defined as confirmed CDI recurrence during and within 30 days after receipt of BSA and/or after greater than or equal to 48 hours of PO VANC PROPH therapy.

Results: Groups were matched for patient age, donor age sex, donor type, donor CMV serostatus and number of transplants. Demographics were similar except for race (Table 1). CDI recurrence rate was not significantly decreased in the PROPH PO VANC cohort vs no PROPH (0% vs 8.2%, p=0.39).

Conclusion: Utilization of oral VANC PROPH for the prevention of CDI in renal transplant patients did not result in a statistically significant reduction in the rate of CDI recurrence when compared to no PROPH. However, the data does support conducting a PROPH study to further explore this intervention.

CITATION INFORMATION: Spliner L, Fose J, Leverson G, Smith J, Saddler C, Jorgenson M. Vancomycin Prophylaxis for Prevention of Clostridium difficile Recurrence in Renal Transplant Patients. Am J Transplant. 2017;17 (suppl 3).

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