1851. Earlier Use of Vancomycin Taper and Pulse (VAN-TP) is More Effective for Managing Clostridium difficile Infection (CDI) Recurrences
Session: Poster Abstract Session: Treatment of HAIs/Antimicrobial Resistant Infections
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • VAN TP ID Week 2015.pdf (235.1 kB)
  • Background:

    Current IDSA/SHEA guidelines recommend treatment of CDI using VAN-TP for episodes beyond the first recurrence although there are few data guiding the design and duration of treatment regimens.  We report the clinical characteristics, regimens, and outcomes for 47 patients who received VAN-TP.

    Methods:

    Charts from patients that were managed at the Loyola Outpatient Care center and who received VAN-TP between August 2011 and June 2014 were reviewed.  Demographic information, CDI history, regimen characteristics, treatment outcomes and subsequent symptom free interval for recurrences (rCDI) were recorded.

    Results:

    47 patients (18 males) received VAN-TP and 26 (56%) had no further rCDI episodes.  The mean symptom free interval following the end of the VAN-TP to rCDI was 34 days for the 21 patients who had subsequent rCDI episodes.  The average age (mean+SD: 62.3+20.8 and 62.0+17.5 years), VAN-TP duration (98.3+62 and 99.4+72 days), and history of VAN-TP exposure prior to management at Loyola (29% and 23%) was similar between patients with and without subsequent rCDI (p=NS).  The mean VAN-TP duration overall was 98 days (range 27-390), with a mean of 18, 38, and 31 days dedicated to the daily, every-other-day, and every third day vancomycin dosing, respectively. These regimens were typically longer than the 6-12 week VAN-TP regimen suggested by the guidelines but were the practice in place in this clinic and varied among patients. Patients experiencing subsequent rCDI were more frequently male [62% (13/21) vs 19% (5/26); p=0.007] and had a history of more prior CDI episodes (3.1+1.2 vs 2.4+0.9 episodes; p=0.03). rCDI patients tended not to receive every third day dosing of vancomycin as part of their VAN-TP regimen [38% (8/21) vs 54% (14/26); p=0.4].  Six of the 21 patients who experienced subsequent rCDI were re-treated with VAN-TP but 4 experienced another recurrence.

    Conclusion:

    VAN-TP appears to be effective for rCDI regardless of patient age and total taper and pulse duration.  More recurrences were observed among men and when VAN-TP was used beyond the first rCDI episode. Inclusion of every third day vancomycin dosing may be helpful.  Additional well-designed studies are needed to confirm the utility of VAN-TP for multiple rCDI episodes.

    Melinda Soriano, PharmD, BCPS, The Medical Affairs Company, LLC, Kennesaw, GA, Carl Manzo, MD, Loyola University Medical Center, Maywood, IL, Dale Gerding, MD, FIDSA, Loyola University and Hines VA Hospital, Hines, IL and Stuart Johnson, MD, FIDSA, Edward Hines, Jr. VA Hospital, Hines, IL

    Disclosures:

    M. Soriano, None

    C. Manzo, None

    D. Gerding, Viropharma/Shire: Consultant , Consulting fee and Licensing agreement or royalty
    Merck: Scientific Advisor , Consulting fee
    Actelion: Scientific Advisor , Consulting fee
    Sanofi Pasteur: Consultant , Consulting fee
    Summit: Scientific Advisor , Consulting fee
    Rebiotix: Scientific Advisor , Consulting fee
    Pfizer: Consultant , Consulting fee
    DaVolterra: Consultant , Consulting fee

    S. Johnson, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.