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Secondary Oral Vancomycin Prophylaxis and Clostridioides difficile Infection in Children and Young Adults With

Isabela DeJohn1, Chunyan Liu2, Caitlin Brammer3

  • 1University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

Open Forum Infectious Diseases
|July 6, 2026
PubMed

Insights

Secondary oral vancomycin prophylaxis (OVP) may reduce recurrent Clostridioides difficile infections (CDI) in pediatric cancer patients receiving antibiotics. This study suggests OVP is associated with a lower risk of CDI recurrence, though further research is needed.

Area of Science:

  • Pediatric Oncology
  • Infectious Diseases
  • Clinical Pharmacology

Background:

  • Recurrent Clostridioides difficile infection (CDI) is a concern in patients with cancer.
  • Limited data exist on secondary oral vancomycin prophylaxis (OVP) for preventing recurrent CDI in pediatric populations.
  • This study investigates OVP's impact in children and young adults with cancer.

Purpose of the Study:

  • To assess the efficacy of secondary oral vancomycin prophylaxis (OVP) in preventing recurrent Clostridioides difficile infection (CDI).
  • To evaluate OVP's role during broad-spectrum antibiotic administration in pediatric cancer patients.
  • To determine the association between OVP and reduced CDI risk post-primary infection.

Main Methods:

  • Retrospective study of pediatric and young adult cancer patients with a primary CDI episode (2017-2024).
  • Utilized propensity score matching and weighted generalized estimating equations.
  • Analyzed CDI recurrence rates during broad-spectrum antibiotic use within 6 months of primary CDI.

Main Results:

  • Fifteen of 72 patients received 27 episodes of OVP during 150 antibiotic courses.
  • CDI occurred in 17.9% of non-OVP courses versus 7.4% of OVP courses.
  • Propensity score matching showed OVP was significantly associated with reduced CDI risk (aOR 0.074).

Conclusions:

  • Secondary oral vancomycin prophylaxis (OVP) was significantly associated with a reduced risk of recurrent Clostridioides difficile infection (CDI) in pediatric cancer patients receiving antibiotics.
  • Findings suggest OVP may be a protective strategy against CDI recurrence in this vulnerable population.
  • Results are hypothesis-generating due to small sample size and potential confounding; larger studies are warranted.
Abstract

Keywords:
Clostridioides difficile infectionoral vancomycin prophylaxispediatric oncologyrecurrent C difficile

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