# Oral Vancomycin in the Treatment of Clostridioides difficile Infection: A Single-Center Observational Study in Southern Poland (2016–2022), Involving 528,887 Hospitalized Patients

## TL;DR

A study in Poland found that vancomycin is effective in treating Clostridioides difficile infection, especially during the pandemic, but highlights the need for better therapies and stewardship.

## Contribution

The study provides real-world evidence on CDI treatment outcomes and pandemic impact in a resource-limited setting.

## Key findings

- Vancomycin-based therapy was associated with significantly lower mortality compared to metronidazole.
- Recurrent CDI occurred in 14.2% of cases, with vancomycin-treated patients showing better relapse-free survival.
- Healthcare-associated CDI surged during the pandemic, reaching 89.2% of infections in 2020.

## Abstract

Objectives: Clostridioides difficile infection (CDI) remains a major healthcare challenge, particularly in resource-limited settings. Methods: This retrospective, single-center study analyzed CDI epidemiology and treatment outcomes among 528,887 hospitalized patients at the University Hospital in Kraków, Poland, between 2016 and 2022. Results: A total of 2341 CDI cases were confirmed, with an overall incidence of 4.32 per 1000 admissions. The highest rates were observed in geriatric and infectious diseases units. During the COVID-19 pandemic, healthcare-associated CDI cases surged, accounting for up to 89.2% of infections in 2020 with an incidence rate of 3.8 per 1000 admissions, compared with 2.5 per 1000 admissions in 2016. Vancomycin-based therapy was associated with significantly lower mortality (OR 0.73, 95% CI 0.56–0.95) compared to metronidazole, while combination therapy (vancomycin, metronidazole) showed the highest recurrence rate (17%). Fidaxomicin use was minimal (0.4%) due to limited availability. Recurrent CDI occurred in 14.2% of cases, with a relapse-free survival advantage observed in vancomycin-treated patients. The overall in-hospital case fatality rate associated with CDI was 22.5%. Conclusions: Despite stable overall CDI incidence, the study highlights the impact of increased antibiotic consumption during the pandemic on HA-CDI dynamics. The findings underscore the need for improved antimicrobial stewardship, broader access to advanced therapies such as fidaxomicin and bezlotoxumab, and enhanced diagnostic protocols. In settings with restricted therapeutic options, vancomycin remains a valuable treatment, particularly for reducing mortality.