Efficacy of prolonged tapered and pulsed vancomycin regimen on recurrent Clostridioides difficile infection in the Japanese setting: a case control study
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Published on: February 14, 2020
Takumi Umemura1,2,3, Aiko Ota1, Yoshikazu Mutoh2,4
11Department of Pharmacy, Tosei General Hospital, 160, Nishi oiwakecho, Seto, Aichi 489-8642 Japan.
Background:
According to the Clinical Practice Guidelines for Clostridioides difficile, oral vancomycin is to be used in vancomycin tapered and pulsed regimen (VCM-TP) for recurrent Clostridium difficile infection (CDI). However, data on the efficacy of VCM-TP in Japanese patients with recurrent CDI are scarce. To address this gap, we investigated the efficacy of VCM-TP and performed a case-controlled study to assess the risk factors associated with treatment failure in these patients.
Findings:
We conducted this study on all patients who were administered VCM-TP for recurrent episodes of CDI between January 2008 and December 2018 at Tosei General Hospital. All patients had documented follow-ups within 90 days after completion of the VCM-TP. Data were obtained for comparative analysis of treatment success or failure. Thirty-six patients were eligible for this study, and treatment success was documented in 23 patients (63.9%) following VCM-TP treatment. Treatment success was documented in 22 of 30 (73.3%) patients who received the recommended therapy according to the Clinical Practice Guidelines. The frequency of patients treated with the recommended therapy was higher in the treatment success group (95.7%) than in the treatment failure group (61.5%) (OR: 13.75, 95% CI: 1.39-136.39, p = 0.016). Vancomycin-resistant enterococci culture tests were performed in 20 patients (55.6%), and all results were negative.
Conclusions:
Our findings suggest that VCM-TP is a good therapeutic option for recurrent CDI in Japanese patients. Furthermore, administration of the recommended VCM-TP is important for achieving a high rate of treatment success. Hence, antimicrobial stewardship teams should support the implementation of recommended VCM-TPs.
Insights
Vancomycin tapered and pulsed regimen (VCM-TP) shows promise for recurrent Clostridioides difficile infection (CDI) in Japanese patients. Adhering to recommended VCM-TP protocols is crucial for successful treatment outcomes.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Pharmacy
Background:
- Clinical Practice Guidelines recommend oral vancomycin tapered and pulsed regimen (VCM-TP) for recurrent Clostridium difficile infection (CDI).
- Limited data exist on VCM-TP efficacy in Japanese patients with recurrent CDI.
- This study investigated VCM-TP efficacy and associated risk factors for treatment failure in this population.
Purpose of the Study:
- To evaluate the efficacy of the vancomycin tapered and pulsed regimen (VCM-TP) for treating recurrent Clostridium difficile infection (CDI) in Japanese patients.
- To identify risk factors associated with treatment failure in patients receiving VCM-TP for recurrent CDI.
Main Methods:
- A case-controlled study was conducted at Tosei General Hospital from January 2008 to December 2018.
- Thirty-six patients with recurrent CDI treated with VCM-TP were analyzed for treatment success or failure within 90 days post-treatment.
- Risk factors for treatment failure were assessed, including adherence to recommended VCM-TP protocols.
Main Results:
- Overall treatment success with VCM-TP was achieved in 63.9% (23/36) of patients.
- Patients receiving the recommended VCM-TP therapy had a higher success rate (73.3%, 22/30) compared to those not adhering to the guidelines.
- Adherence to the recommended VCM-TP was significantly associated with treatment success (OR: 13.75, p=0.016).
- Vancomycin-resistant enterococci were not detected in tested patients.
Conclusions:
- Vancomycin tapered and pulsed regimen (VCM-TP) is a viable therapeutic option for recurrent Clostridium difficile infection (CDI) in Japanese patients.
- Strict adherence to recommended VCM-TP protocols is essential for maximizing treatment success rates.
- Antimicrobial stewardship programs should promote the implementation of evidence-based VCM-TP guidelines.
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