P-143. Oral Vancomycin Prophylaxis to Control an Outbreak of Clostridium difficile Infection in ICU Patients in a Large Urban Safety Net Hospital

TL;DR

Using oral vancomycin prophylaxis in ICU patients helped reduce Clostridium difficile infections during an outbreak and the effect lasted for six months.

Contribution

Demonstrates that targeted oral vancomycin prophylaxis can effectively control Clostridium difficile outbreaks in ICU settings.

Findings

HO-CDI rates in ICUs dropped from 1.91 to 0.38 cases/1000 patient-days during prophylaxis and remained low for six months.

Vancomycin-resistant enterococci rates in ICUs remained stable across all periods.

HO-CDI rates outside ICUs were unaffected by the prophylaxis protocol.

Abstract

Hospital-onset Clostridioides difficile infection (HO-CDI) is associated with significant clinical and economic consequences. Use of broad-spectrum antibiotics for patients in the Intensive Care Units (ICUs) is the leading risk for HO-CDI. Hospital outbreaks may still develop despite comprehensive antimicrobial stewardship programs and infection control measures.

In response to a large tertiary care urban hospital CDI outbreak in the adult medical and surgical ICUs, a program of primary oral vancomycin prophylaxis (OVP) for select high-risk patients was initiated. Primary prophylaxis was administered for patients ≥ 60 years of age, hospitalized for ≥ 7 days, and receiving a beta-lactam, fluoroquinolone, and/or clindamycin. The Outbreak Period was from Oct 1, 2023 through Mar 15, 2024. The Prophylaxis Period started Mar 16, 2024 and terminated on Aug 31, 2024; a Follow-up Period then was from Sep 1, 2024 to Feb 28, 2025. Patients outside the ICUs were not administered OVP. The number of cases of incident HO-CDI and vancomycin-resistant enterococci (VRE) cases were gathered; rates of infection were determined using the number of patient-days for the ICUs and for the remainder of the hospital during each time period.

In the ICUs during the Outbreak Period, there were 1.91 HO-CDI cases/1000 patient-days. During the Prophylaxis Period, this fell to 0.38 cases/1000 patient days (P=.02). This decrease in HO-CDI cases in the ICUs was sustained during the 6-month Follow-up Period (0.66 cases/1000 patient days, P=.06 compared to Outbreak Period). For patients outside the ICUs, rates of HO-CDI remained unchanged during the three periods: 0.20, 0.29, and 0.13 cases/1000 patient days, P=NS). The rate of VRE cases in the ICUs remained stable during the three time periods: 0.70, 1.52, and 0.82 cases/1000 patient days (P=NS).

A restricted protocol of primary OVP helped terminate a sustained outbreak of HO-CDI in ICU patients; the favorable impact continued for 6 months after stopping primary OVP. OVP may be an effective option for preventing and controlling CDI in high-risk settings.

All Authors: No reported disclosures