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Fri AM ID Fellow Conference! The amazing @_CatherineLi, PharmD chatting about Cdiff!! Join us and comment on some highlights! #IDTwitter #MedTwitter #tweetorial #IDMedEd
What is Cdiff doing in the US?
Did you catch this recent paper on Cdiff trends? The national burden of CDI and associated hospitalization has been decreasing 2011-->2017 due to decline in health care associated infection. Woohoo!
https://bit.ly/3bWgMZY
The classic #MedstudentTwitter question: which antibiotics carry the highest risk for Cdiff?
Here's the results from a meta-analysis of abx exposure and community acquired CDI, included 8 studies
1. Clinda (OR 20.43, 95% CI 8.50–49.09)
2. Fluoroquinolones (OR 5.65, 95% CI 4.38–7.28)
3. Cephalosporins (OR 4.47, 95% CI 1.60–12.50)
4. PCNs (OR 3.25, 95% CI 1.89–5.57)
1. Clinda (OR 20.43, 95% CI 8.50–49.09)
2. Fluoroquinolones (OR 5.65, 95% CI 4.38–7.28)
3. Cephalosporins (OR 4.47, 95% CI 1.60–12.50)
4. PCNs (OR 3.25, 95% CI 1.89–5.57)
One interesting point, tetracyclines were not associated with increased CDI risk (OR 0.91, 95% CI 0.57–1.45), so is it maybe low risk or even protective against Cdiff?
As if you needed another reason to like doxy
https://bit.ly/2Tub2Aa
As if you needed another reason to like doxy
https://bit.ly/2Tub2Aa
Another poll: how do you feel about Cdiff prevention with PO Vancomycin?
Primary and secondary ppx for cdiff is not standard with regards to agent selection, dosing, duration. Evidence for efficacy is conflicting. So let's take a look. Let's first look at argument for possible benefit.
Pro#1:
Retrosp cohort, 2 ctrs
551 CDI episodes with subsequent abx exposure
41% episodes received oral vanc ppx (80% pts took 125 QID dose)
CDI recurrence for pts with h/o recurrence (AHR 0.47,p<0.0001)
Did not demonstrate benefit if 1 episode
https://bit.ly/2zcoC4r
Retrosp cohort, 2 ctrs
551 CDI episodes with subsequent abx exposure
41% episodes received oral vanc ppx (80% pts took 125 QID dose)
CDI recurrence for pts with h/o recurrence (AHR 0.47,p<0.0001)Did not demonstrate benefit if 1 episode
https://bit.ly/2zcoC4r
Pro #2
Retrosp cohort
Comp'd recurrent CDI with systemic abx in 203 pts
Oral vanc ppx in 113 pts (doses 250 or 125 BID)
No vanco in 132 pts
Incidence of CDI was significantlyin ppx grp (4.2%) vs those w/o (26.6%)
(OR 0.12; 95% CI .04–.4; P < .001)
https://bit.ly/36nrxDj
Retrosp cohort
Comp'd recurrent CDI with systemic abx in 203 pts
Oral vanc ppx in 113 pts (doses 250 or 125 BID)
No vanco in 132 pts
Incidence of CDI was significantly
in ppx grp (4.2%) vs those w/o (26.6%)(OR 0.12; 95% CI .04–.4; P < .001)
https://bit.ly/36nrxDj
Counter:
Multictr retrosp cohort
760 inpt with h/o CDI receiving abxs
193 pts received oral vanc (doses not listed)
Risk of CDI relapse w/i 90d after systemic abxs was similar bt those did + did not receive Vanc (9.8%, 9.4%, respectiv)
Cont'd below
https://bit.ly/2TrTWCP
Multictr retrosp cohort
760 inpt with h/o CDI receiving abxs
193 pts received oral vanc (doses not listed)
Risk of CDI relapse w/i 90d after systemic abxs was similar bt those did + did not receive Vanc (9.8%, 9.4%, respectiv)
Cont'd below
https://bit.ly/2TrTWCP
Oral vanco ppx was effective for risk of relapse only for pts with just 1 prior CDI (OR 0.42) but not multiple ?
See this @JWatch for a possible explanation of what seem counter-intuitive:
https://bit.ly/2ZnSBB0
See this @JWatch for a possible explanation of what seem counter-intuitive:
https://bit.ly/2ZnSBB0
This is a big topic -- Let us know your thoughts on the debate, would love to hear how other #IDtwitter folks approach CDI ppx at their hospital!
