728 - Prophylactic Vancomycin Therapy in Long Term Care Patients Colonized with Clostridioides difficile to Reduce Hospital-Acquired C. diff Infection

Background: Clostridioides difficile (C. diff) is a common hospital-acquired infection with increasing rates of morbidity and mortality in elderly patients. Per the CDC, there are about 500,000 cases yearly in which 1 out of 11 patients die over the age of 65 due to complications from healthcare-associated C. diff infection (CDI). Oral Vancomycin has been shown to prevent recurrent CDI. Approximately 40% of patients admitted to Good Samaritan Hospital (GSH), who were colonized with C. diff developed active CDI while on antibiotic therapy during their hospitalization. In January 2017, GSH initiated a quality improvement intervention in which all patients admitted from long term care (LTC) facilities who were positive for C. diff colonization were given prophylactic oral Vancomycin with prescribed antibiotics.

Methods: This study is a retrospective cohort study within TriHealth facilities. The population included hospitalized patients from extended care, intermediate care, subacute rehabilitation, and nursing homes, who tested positive for C. Diff colonization from April 1, 2017, through June 30, 2018. Patients were screened for risk factors for C. diff. The primary outcomes were to determine whether patients developed CDI within 90-days of discharge and to evaluate for any events of CDI during their hospital stay.

Results: Among the 1,241 LTC patients who were admitted and screened for C. diff colonization, 213 (17%) were positive, 135 (63%) met inclusion criteria, and 5 (4%) patients who were admitted with CDI were excluded. 0% of patients treated with low dose Vancomycin developed CDI during their hospital stay, and a total of 5% of patients were found to have recurrent CDI within 90-day of hospital discharge.  Patients who were already on antibiotics at the time of admission were at a higher risk of developing CDI (60% vs. 15%, p=0.034).  Adherence to the study protocol was 78.5% and 19% of patients did not receive low-dose Vancomycin while on antibiotic therapy.Image 1: Screening diagram to select patients for study
Table 1: Population characteristics


Conclusion: Review of CDI via TriHealth statistics revealed an overall reduction of hospital-acquired CDI since the implementation of prophylactic oral Vancomycin therapy. The next step will be to determine the duration of low dose vancomycin therapy for the prevention of future CDI as some patients did develop CDI within 90 days of discharge.Image 2: C. diff infection rate throughout TriHealth facilities (Post Vancomycin prophylaxis)