Primary Oral Vancomycin Prophylaxis Reduces the Incidence of Clostridium difficile Infection among Lung Transplant Recipients
Cleveland Clinic Foundation, Cleveland, OH.
Meeting: 2018 American Transplant Congress
Abstract number: C258
Keywords: Bacterial infection, Efficacy, Lung transplantation, Post-operative complications
Session Information
Date: Monday, June 4, 2018
Session Name: Poster Session C: Lung: All Topics
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Purpose: To determine the efficacy of primary oral vancomycin prophylaxis in reducing the incidence of Clostridium difficile infection (CDI) in the early post-op period among lung transplant recipients (LTR).
We reviewed all medical records of LTR from 1/1/2007 through 6/30/2013. We excluded those with CDI within one year pre-transplant. We then compared the incidence of CDI in LTR exposed to vancomycin prophylaxis to the incidence in recipients not exposed to vancomycin prophylaxis.
We identified 484 LTR, of which 54 received primary oral vancomycin prophylaxis and 430 of which did not. See table for clinical features.
| Characteristics | Oral Vanc primary prophylaxis
N=54 (%) |
No primary prophylaxis N=430 (%) | P-value |
| Mean Age (+/- SD), years | 55 (13) | 57 (12) | |
| Median Charlson comorbidity index (IQR) | 5 (4-7) | 5 (4-6) | |
| Indication | |||
| CF | 8 (15) | 38 (9) | |
| IPF | 23 (43) | 148 (34) | |
| COPD | 10 (19) | 72 (17) | |
| Median LOS (IQR), days | 28 (19-50) | 19 (12-35) | |
| Antibiotic exposure | |||
| Median duration systemic agent (IQR), days | 14 (12-22.5) | 12 (6-26) | |
| Median overlap p.o. vanc and systemic agent (IQR), days | 7.5 (4-14) | N/A | |
| β-lactam-β-lactamase inhibitor | 46 (85) | 299 (70) | 0.02 |
| Carbapenem | 35 (65) | 50 (12) | <0.01 |
| Fluoroquinolone | 30 (56) | 178 (41) | 0.04 |
| In-hospital incidence rate of CDI (95% CI) | 3.9 (0.2-19) | 19.5 (13-28) | 0.06 |
| One-year mortality after CDI | 0/1 (0) | 7/27 (26) |
The overall in-hospital incidence rate of CDI was 17 cases per 10,000 patient days (95% CI=12-24). One patient in the oral vancomycin prophylaxis group developed CDI as compared to 27 patients within the no primary prophylaxis group. The rate ratio = 0.2 (95% CI = 0.01-1.07; p=0.06). Importantly, 7 of the 27 patients who developed CDI in the no prophylaxis group died within one year, a 26% one year mortality as compared to a 0% one year mortality in the oral vancomycin prophylaxis group.
In conclusion, our data set comparing the in-hospital incidence rate of CDI between patients exposed to oral vancomycin primary prophylaxis and those receiving no prophylaxis illustrates that oral vancomycin prophylaxis was associated with an 80% reduction in C. difficile infection incidence.
CITATION INFORMATION: Bajrovic V., Brizendine K. Primary Oral Vancomycin Prophylaxis Reduces the Incidence of Clostridium difficile Infection among Lung Transplant Recipients Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Bajrovic V, Brizendine K. Primary Oral Vancomycin Prophylaxis Reduces the Incidence of Clostridium difficile Infection among Lung Transplant Recipients [abstract]. https://atcmeetingabstracts.com/abstract/primary-oral-vancomycin-prophylaxis-reduces-the-incidence-of-clostridium-difficile-infection-among-lung-transplant-recipients/. Accessed January 25, 2021.« Back to 2018 American Transplant Congress