Screening and targeted prophylaxis for Clostridioides difficile infection.

Area of Science:

• Infectious Diseases
• Oncology
• Transplantation Medicine

Background:

• Immunocompromised patients undergoing oncology treatment or solid organ transplantation face a high risk of hospital-onset Clostridioides difficile infection (HO-CDI).
• Effective strategies are needed to mitigate HO-CDI risk in these vulnerable patient populations.

Purpose of the Study:

• To evaluate the impact of a prophylactic enteral vancomycin intervention on reducing HO-CDI rates.
• To assess the intervention's effect on C. difficile colonization and related clinical outcomes in high-risk inpatients.

Main Methods:

• The Screening and Targeted Prophylaxis (STOP) intervention involved screening high-risk patients (transplant, CAR-T, leukemia) for C. difficile colonization.
• Colonized patients received prophylactic enteral vancomycin and contact isolation.
• Outcomes were compared to historical controls from the two years prior to intervention implementation.

Main Results:

• The intervention group showed significantly lower odds of HO-CDI (0.88% vs 5.6%) compared to weighted controls (OR 0.15).
• Significant reductions were observed in 90-day CDI, stool output, and length of stay.
• No significant differences were found in VRE infection or mortality rates.

Conclusions:

• The STOP intervention effectively reduced HO-CDI in immunocompromised patients.
• Prophylactic enteral vancomycin is a viable strategy to decrease C. difficile-related morbidity and healthcare resource utilization in high-risk cohorts.