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. 2021 Feb 23:14:1756284821994046.
doi: 10.1177/1756284821994046. eCollection 2021.

Efficacy of oral vancomycin prophylaxis for prevention of Clostridioides difficile infection: a systematic review and meta-analysis

Raseen Tariq  1 , Maryrose Laguio-Vila  2 , Muhammad Waqas Tahir  3 , Robert Orenstein  4 , Darrell S Pardi  5 , Sahil Khanna  6
Affiliations

Efficacy of oral vancomycin prophylaxis for prevention of Clostridioides difficile infection: a systematic review and meta-analysis

Raseen Tariq et al. Therap Adv Gastroenterol. .

Abstract

Background: Prevention of recurrent Clostridioides difficile infection (CDI) is a challenge in clinical practice, particularly in patients who need systemic antimicrobial therapy. We aimed to evaluate the role of oral vancomycin prophylaxis (OVP) in prevention of primary or future CDI in patients on systemic antimicrobial therapy.

Methods: A systematic search of MEDLINE, Embase, and Web of Science was performed from 2000 to January 2020. We included case-control or cohort studies that included patients on systemic antimicrobial therapy who did or did not receive oral vancomycin prophylaxis (OVP) and were evaluated for development of CDI. Odds ratio (OR) estimates with 95% confidence intervals (CI) were calculated.

Results: Four studies including 1352 patients evaluated OVP for primary CDI prevention, with CDI occurring in 29/402 patients on OVP (7.4%) compared with 10.4% (99/950) without OVP. Meta-analysis revealed no significant decrease in risk of CDI in patients who received OVP (OR, 0.18; 95% CI, 0.03-1.03; p = 0.06). There was significant heterogeneity with I 2 = 76%. Ten studies including 9258 patients evaluated OVP for secondary CDI prevention. Future CDI occurred in 91/713 patients on OVP (13.3%) compared with 21.9% (1875/8545) who did not receive OVP. Meta-analysis revealed a statistically significant decreased risk of future CDI (OR, 0.34; 95% CI, 0.20-0.59; p < 0.00001). Significant heterogeneity was seen with I 2 = 59%.

Discussion: Based on observational data, OVP appears to decrease the risk of future CDI in patients with prior CDI who require systemic antimicrobial therapy. However, OVP was not effective for primary prevention of CDI.

Keywords: C. difficile; antibiotics; diarrhea; oral vancomycin; prophylaxis.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow diagram of study selection process.
Figure 2.
Figure 2.
Analysis of studies that evaluated oral vancomycin for primary CDI prophylaxis, showing no prevention benefit. CDI, Clostridioides difficile infection; CI, confidence interval; OPV, oral vancomycin prophylaxis.
Figure 3.
Figure 3.
Analysis of studies that evaluated oral vancomycin for recurrent CDI prophylaxis, showing statistically significant decreased risk of CDI. CDI, Clostridioides difficile infection; CI, confidence interval; OPV, oral vancomycin prophylaxis.
Figure 4.
Figure 4.
Three studies that controlled for potential confounders plot demonstrates decreased risk of recurrent CDI with OVP by the random-effects mode. CDI, Clostridioides difficile infection; CI, confidence interval; OPV, oral vancomycin prophylaxis; SE, standard error.
See this image and copyright information in PMC

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