Vancomycin Enemas as Adjunctive Therapy for Clostridium difficile Infection

Area of Science:

• Infectious Diseases
• Gastroenterology
• Critical Care Medicine

Background:

• Severe, complicated Clostridium difficile infection (CDI) often requires intravenous metronidazole and oral vancomycin.
• Vancomycin per rectum (VPR) is sometimes used to enhance colonic drug delivery in CDI cases.
• Clinical outcomes of VPR use in CDI require further investigation.

Purpose of the Study:

• To examine the clinical outcomes of patients with CDI treated with VPR.
• To compare these outcomes to a matched control group not receiving VPR.

Main Methods:

• Retrospective case-control study of intensive care unit (ICU) patients with positive C. difficile toxin tests.
• VPR doses ranged from 125 to 250 mg every 6-8 hours.
• Primary outcome: combined colectomy or death; matched VPR cases 1:2 with controls by APACHE II score.

Main Results:

• 24 patients received VPR; 4 (16.7%) required colectomy, and 45.8% experienced mortality.
• 48 controls showed identical colectomy rates (16.7%) and similar mortality (41.7%).
• Combined endpoint of surgery or death was not significantly different between VPR and control groups (50.0% vs. 45.8%, P = 0.73).

Conclusions:

• The use of VPR in severe CDI did not reduce the need for colectomy or decrease mortality.
• Given the modest sample size and lack of demonstrated efficacy, strong advocacy for VPR use is not supported.
• Further research may be needed to clarify the role of VPR in specific CDI patient populations.