Thread by @BIDMC_IDFellows, Fri AM ID Fellow Conference! The amazing @_CatherineLi, PharmD chatting about Cdiff!! [...]

Fri AM ID Fellow Conference! The amazing @_CatherineLi, PharmD chatting about Cdiff!! Join us and comment on some highlights! #IDTwitter #MedTwitter #tweetorial #IDMedEd

https://abs.twimg.com/emoji/v2/... draggable="false" alt="❓" title="Red question mark ornament" aria-label="Emoji: Red question mark ornament">What is Cdiff doing in the US?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✳️" title="Eight spoked asterisk" aria-label="Emoji: Eight spoked asterisk">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 ">https://bit.ly/3bWgMZY&q...

What is Cdiff doing in the US?https://abs.twimg.com/emoji/v2/... draggable="false" alt="✳️" title="Eight spoked asterisk" aria-label="Emoji: Eight spoked asterisk">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&q..." title="https://abs.twimg.com/emoji/v2/... draggable="false" alt="❓" title="Red question mark ornament" aria-label="Emoji: Red question mark ornament">What is Cdiff doing in the US?https://abs.twimg.com/emoji/v2/... draggable="false" alt="✳️" title="Eight spoked asterisk" aria-label="Emoji: Eight spoked asterisk">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&q..." class="img-responsive" style="max-width:100%;"/>

The classic #MedstudentTwitter question: which antibiotics carry the highest risk for Cdiff?

Here& #39;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)

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 ">https://bit.ly/2Tub2Aa&q...

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& #39;s take a look. Let& #39;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)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Downwards arrow" aria-label="Emoji: Downwards arrow">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 ">https://bit.ly/2zcoC4r&q...

Pro #1:Retrosp cohort, 2 ctrs551 CDI episodes with subsequent abx exposure41% episodes received oral vanc ppx (80% pts took 125 QID dose)https://abs.twimg.com/emoji/v2/... draggable=

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&q..." title="Pro #1:Retrosp cohort, 2 ctrs551 CDI episodes with subsequent abx exposure41% episodes received oral vanc ppx (80% pts took 125 QID dose)https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Downwards arrow" aria-label="Emoji: Downwards arrow">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&q...">

Pro #2
Retrosp cohort
Comp& #39;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

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Downwards arrow" aria-label="Emoji: Downwards arrow">in ppx grp (4.2%) vs those w/o (26.6%)
(OR 0.12; 95% CI .04–.4; P < .001)
https://bit.ly/36nrxDj ">https://bit.ly/36nrxDj&q...

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& #39;d below
https://bit.ly/2TrTWCP ">https://bit.ly/2TrTWCP&q...

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 ">https://bit.ly/2ZnSBB0&q...

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!

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