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Systematic Review

Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

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First Division of Infectious Diseases, Cotugno Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
2
Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
3
Infectious and Tropical Diseases Unit, Padua University Hospital, 35121 Padua, Italy
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Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
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Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani, IRCCS, 00149 Rome, Italy
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Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy
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Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy
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Infectious Diseases Service, Saint Camillus International University of Health Science, UniCamillus, 00131 Rome, Italy
*
Author to whom correspondence should be addressed.
Academic Editor: Michael Samarkos
Antibiotics 2022, 11(2), 183; https://doi.org/10.3390/antibiotics11020183
Received: 30 December 2021 / Revised: 26 January 2022 / Accepted: 28 January 2022 / Published: 30 January 2022
Background: Clostridioides difficile infection (CDI) is associated with substantial morbidity and mortality as well as high propensity of recurrence. Systemic antibiotic therapy (SAT) represents the top inciting factor of CDI, both primary and recurrent (rCDI). Among the many strategies aimed to prevent CDI in high-risk subjects undergoing SAT, oral vancomycin prophylaxis (OVP) appears promising under a cost-effectiveness perspective. Methods: A systematic review with meta-analysis and trial sequential analysis (TSA) of studies assessing the efficacy and the safety of OVP to prevent primary CDI and rCDI in persons undergoing SAT was carried out. PubMed and EMBASE were searched until 30 September 2021. The protocol was pre-registered on PROSPERO (CRD42019145543). Results: Eleven studies met the inclusion criteria, only one being a randomized controlled trial (RCT). Overall, 929 subjects received OVP and 2011 represented the comparator group (no active prophylaxis). OVP exerted a strong protective effect for CDI occurrence: odds ratio 0.14, 95% confidence interval 0.04–0.38. Moderate heterogeneity was observed: I2 54%. This effect was confirmed throughout several subgroup analyses, including prevention of primary CDI versus rCDI. TSA results pointed at the conclusive nature of the evidence. Results were robust to a variety of sensitivity and quantitative bias analyses, although the underlying evidence was deemed as low quality. No differences between the two groups were highlighted regarding the onset of vancomycin-resistant Enterococcus infections. Conclusions: OVP appears to be an efficacious option for prevention of CDI in high-risk subjects undergoing SAT. Nevertheless, additional data from RCTs are needed to establish OVP as good clinical practice and define optimal dosage and duration. View Full-Text
Keywords: Clostridioides difficile; oral vancomycin; prevention; prophylaxis; meta-analysis; trial sequential analysis; antibiotic Clostridioides difficile; oral vancomycin; prevention; prophylaxis; meta-analysis; trial sequential analysis; antibiotic
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MDPI and ACS Style

Maraolo, A.E.; Mazzitelli, M.; Zappulo, E.; Scotto, R.; Granata, G.; Andini, R.; Durante-Mangoni, E.; Petrosillo, N.; Gentile, I. Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis. Antibiotics 2022, 11, 183. https://doi.org/10.3390/antibiotics11020183

AMA Style

Maraolo AE, Mazzitelli M, Zappulo E, Scotto R, Granata G, Andini R, Durante-Mangoni E, Petrosillo N, Gentile I. Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis. Antibiotics. 2022; 11(2):183. https://doi.org/10.3390/antibiotics11020183

Chicago/Turabian Style

Maraolo, Alberto Enrico, Maria Mazzitelli, Emanuela Zappulo, Riccardo Scotto, Guido Granata, Roberto Andini, Emanuele Durante-Mangoni, Nicola Petrosillo, and Ivan Gentile. 2022. "Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis" Antibiotics 11, no. 2: 183. https://doi.org/10.3390/antibiotics11020183

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