Oral Vancomycin Monotherapy Versus Combination Therapy in Solid Organ Transplant Recipients With Uncomplicated Clostridium difficile Infection: A Retrospective Cohort Study

Transplant Proc. 2018 Jan-Feb;50(1):137-141. doi: 10.1016/j.transproceed.2017.11.016.

Abstract

Introduction: Solid organ transplant (SOT) recipients are at high risk of Clostridium difficile infection (CDI) and CDI recurrence due to their suppressed immune systems and antibiotic exposure. A combination of metronidazole and oral vancomycin is often prescribed for SOT recipients with uncomplicated CDI despite any clinical practice guidelines supporting the need for combination therapy. This study aims to compare the CDI recurrence rates of metronidazole/vancomycin combination therapy to oral vancomycin monotherapy in SOT recipients after a first episode of uncomplicated CDI.

Methods: A single-center retrospective cohort study evaluated SOT recipients diagnosed with uncomplicated CDI who were treated with vancomycin monotherapy or vancomycin/metronidazole combination therapy. The primary endpoint was CDI recurrence defined as a second CDI episode within 8 weeks of completing index CDI therapy. The secondary endpoints were time between the end of CDI therapy and recurrence, length of total hospitalization after the index CDI, and length of hospitalization after index CDI diagnosis.

Results: Fifteen patients (25%) of 61 subjects experienced CDI recurrence. There was no statistically significant difference in CDI recurrence rate between the vancomycin monotherapy group and combination therapy group (23% versus 27%, respectively; P = .715). The median total length of hospitalization between the vancomycin monotherapy and combination therapy groups was statistically significant (9 versus 14 days, respectively; P = .047).

Discussion: There was no difference found in recurrence rate between oral vancomycin monotherapy versus combination therapy. The study result weakens the practice of prescribing combination therapy for uncomplicated CDI in SOT recipients.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Clostridioides difficile
  • Clostridium Infections / drug therapy*
  • Clostridium Infections / epidemiology*
  • Drug Therapy, Combination
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Metronidazole / administration & dosage
  • Metronidazole / therapeutic use*
  • Middle Aged
  • Organ Transplantation / adverse effects
  • Postoperative Complications / drug therapy
  • Postoperative Complications / epidemiology*
  • Recurrence
  • Retrospective Studies
  • Vancomycin / administration & dosage
  • Vancomycin / therapeutic use*

Substances

  • Anti-Bacterial Agents
  • Metronidazole
  • Vancomycin