Screening and targeted prophylaxis for Clostridioides difficile infection

Patients receiving immunosuppression for oncology treatment and solid organ transplantation are at high risk for developing hospital-onset Clostridioides difficile infection (HO-CDI). We studied the impact of a prophylactic enteral vancomycin intervention on the reduction of HO-CDI during high-risk inpatient admissions among immunocompromised patients.

The screening and targeted prophylaxis (STOP) intervention was implemented over a 2-year period. Patients admitted for solid organ transplant, autologous stem cell transplant, chimeric antigen receptor T-cell, or treatment for leukaemia were screened for colonization with C. difficile. Colonized patients were placed in contact isolation and were advised to start anti-C.difficile antibiotic prophylaxis. To assess the effect of this intervention on both C.difficile testing and incident HO-CDI, comparison was made to historical controls in the 2 years before implementation of the STOP intervention, both unweighted and weighted by treatment category and separately by treatment category and severity of illness.

From November 2021 to December 2023, 696 patients were screened for C difficile, among whom 11.1% (77/696) were found to be colonized and received the prophylactic intervention. Compared with treatment-weighted controls, the odds of HO-CDI were significantly lower in the intervention group (6/696 [0.88%] vs. 81/1450 [5.6%]; odds ratio [OR], 0.15; 95% Credible Interval [CrI], 0.06-0.30). Significant reductions in 90-day CDI (OR 0.40, 95% CrI 0.25-0.64), stool output (incidence rate ratio, 0.84; 95% CrI, 0.77-0.92), and length of stay (-2.5 days; 95% CrI, -3.4 to -1.5) were also observed in the intervention group. There was no detected difference in vancomycin-resistant Enterococci infection (OR, 0.77; 95% CrI, 0.33-1.75) or mortality (OR, 0.44; 95% CrI, 0.11-1.49).

The STOP intervention was effective at reducing HO-CDI, length of stay, and symptoms of C difficile in this high-risk cohort.