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Primary Prevention of Clostridioides difficile Infection With Oral Vancomycin in Pediatric Hematopoietic Stem Cell

Heather Valdin1, Blake Gray2, Gregory Cook3

  • 1Department of Pediatric Hematology Oncology, Louisiana State University Health Sciences Center and Manning Family Children's, New Orleans, Louisiana, USA.

Pediatric Transplantation
|December 3, 2025
PubMed

Insights

Empiric oral vancomycin prophylaxis (OVP) significantly reduced Clostridioides difficile infection (CDI) incidence in pediatric hematopoietic stem cell transplant (HSCT) patients. This study found OVP to be safe and effective for preventing initial CDI during HSCT admission.

Area of Science:

  • Pediatric Hematology/Oncology
  • Infectious Diseases
  • Transplant Immunology

Background:

  • Clostridioides difficile infection (CDI) is a significant threat to pediatric hematopoietic stem cell transplant (HSCT) recipients.
  • Existing evidence primarily supports oral vancomycin prophylaxis (OVP) for recurrent CDI, with limited data on its use for initial infection prevention.
  • Our institution utilizes empiric OVP for initial CDI prevention during the first HSCT admission.

Purpose of the Study:

  • To determine the incidence of CDI in pediatric HSCT recipients receiving OVP.
  • To evaluate secondary outcomes associated with OVP use, including VRE infections, refractory CDI, and acute gastrointestinal graft-versus-host disease (GI GVHD).

Main Methods:

  • A single-center, retrospective observational study was conducted.
  • Data from 84 pediatric HSCT recipients receiving OVP during their initial transplant admission were analyzed.
  • Chart review collected demographic, transplant, and clinical outcome data, focusing on CDI incidence, VRE, refractory CDI, and acute GI GVHD.

Main Results:

  • A single patient (1.19%) developed CDI while on OVP, despite broad-spectrum antibiotic use in the cohort.
  • No vancomycin-resistant Enterococcus (VRE) infections were observed.
  • Rates of GI GVHD were comparable to national averages, and nine patients (10.7%) developed CDI after OVP cessation, all managed successfully.

Conclusions:

  • Empiric OVP during pediatric HSCT hospitalization demonstrated a significantly low incidence of initial CDI.
  • No adverse effects related to OVP were identified, even with long-term follow-up.
  • Findings support the safety and potential efficacy of OVP as a primary prophylactic agent against CDI in pediatric HSCT patients.
Abstract

Keywords:
Clostridioides difficile infection preventionoral vancomycin prophylaxispediatric bone marrow transplant

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