Oral vancomycin for Clostridioides difficile prophylaxis in allogenic hematopoietic cell transplant

Neutropenia and antibiotic use put patients at risk for Clostridioides difficile infection (CDI) following allogenic hematopoietic cell transplant (alloHCT). CDI following alloHCT has been associated with acute graft-versus-host disease (aGVHD), a significant cause of morbidity and mortality in this population. We sought to evaluate if prophylactic oral vancomycin reduces the incidence of CDI in alloHCT recipients.

We conducted a single-center retrospective chart review to compare the effectiveness of oral vancomycin prophylaxis versus no prophylaxis in alloHCT recipients at the University of Kansas Health System. Vancomycin for CDI prophylaxis was implemented in March of 2018 at the University of Kansas Health System. Review of 100 consecutive alloHCT patients before and after this implementation was used to compare outcomes. Patients received oral vancomycin 125 mg twice daily, starting on the day of inpatient admission for alloHCT and continued until discharge. The primary outcome is the incidence of CDI in patients with oral vancomycin prophylaxis compared to those who did not receive prophylaxis during hospital admission for alloHCT. The secondary endpoints include the incidence of acute grades 2-4 GVHD, and event-free survival for each arm.

Eleven percent of patients developed CDI in the control group versus 2% of patients in the intervention group (p = .018). Oral vancomycin was not associated with a higher risk of acute GVHD grades 2-4 (36% vs. 38%; p = .77) at day 100 post transplant. No difference was seen in event-free survival.

Oral vancomycin was associated with reduced CDI incidence in patients that underwent an alloHCT without negatively affecting posttransplant outcomes. The contribution of confounders cannot be excluded.