Ponce-Terashima R. IDSA 2012 abs.293

1. 1 of 2 Effect of prolonging Clostridium difficile (CD) treatment on recurrence rate in patients receiving concomitant systemic antibiotic therapy 5-yr retrospective single-centre study in 301 patients with first episode of Clostridium difficile infection (CDI) (period 2007-2011) Bivariate analysis of 65 patients with concomitant systemic antibiotic therapy* and follow-up of ≥12 wk: 23 patients with standard CD treatment duration (35%) 42 patients with prolonged CD treatment duration (defined as ≥15 days; 65%) Highest CDI recurrence rate in patients receiving oral vancomycin: 36% for vancomycin alone 50% for vancomycin and metronidazole 20% for metronidazole alone Ponce-Terashima R. IDSA 2012 abs.293

2. 2 of 2 Effect of prolonging Clostridium difficile (CD) treatment on recurrence rate in patients receiving concomitant systemic antibiotic therapy Prolonging CD treatment in patients on concomitant antibiotics may not reduce the CDI recurrence rate Ponce-Terashima R. IDSA 2012 abs.293

3. Differential risk of antibiotics on community-associated Clostridium difficile infection (CDI) • Meta-analysis of 4 observational studies comparing antibiotic vs non-antibiotic use in non-hospitalised patients (retrieved from 465 publications from 2 databases by 2 independent reviewers) In the community setting, there seems to be substantial variation between different antibiotic classes for the risk of CDI Brown K. IDSA 2012 abs.723

4. 1 of 2 Impact of probiotics on occurrence of Clostridium difficile infection (CDI) in patients receiving high-risk antibiotics Retrospective cohort study in adult inpatients who received antibiotics (with high risk of acquiring CDI) during ≥5 days in the period July-Dec 2010 Selected high-risk antibiotics: clindamycin, ceftriaxone, ciprofloxacin, levofloxacin Patient demographics, comorbidities, probiotics use (Lactobacillus GG and Saccharomyces boulardii), concomitant proton pump inhibitor (PPI) use 20 of 389 (5.1%) had CDI within 90 days of antibiotic use: Dickson J. IDSA 2012 abs.299

5. 2 of 2 Impact of probiotics on occurrence of Clostridium difficile infection (CDI) in patients receiving high-risk antibiotics • 65% of patients who developed CDI used levofloxacin but even after adjusting for levofloxacin use, risk remains 2.6-fold higher for probiotics users compared with non-users (P<0.05) • Effect of concomitant PPI use on occurrence of CDI: The use of probiotics seems to increase the risk of CDI in patients on high-risk antibiotics; concomitant PPI use may even further increase this risk Dickson J. IDSA 2012 abs.299

6. 1 of 2 Colonoscopic vs nasogastric faecal transplantation for treatment of Clostridium difficile infection (CDI) Pooled analysis of study data (published until December 2011) on faecal transplantation for recurrent CDI 12 studies with 182 patients Postigo R. IDSA 2012 abs.315

7. 2 of 2 Colonoscopic vs nasogastric faecal transplantation for treatment of Clostridium difficile infection (CDI) • No significant AEs were noted Faecal transplantation for recurrent CDI via colonoscopy or nasogastric tube appears highly and equally effective, and safe Postigo R. IDSA 2012 abs.315

8. 1 of 2 Outcome of intestinal microbiota transplantation on death/colectomy in patients with severe/fulminant Clostridium difficile infection (CDI) Single-centre retrospective study (period May 2010-Dec 2011) in 28 patients with severe/fulminant colitis due to CDI (median age 60 yr) unresponsive to conventional CDI therapy Donors for intestinal microbiota transplantation: screened for negative serology for HIV, hepatitis A/B/C and syphilis, stool tested by PCR for negative C. difficile DNA Outcome: Primary: clinical improvement (resolution of diarrhoea) Secondary: CDI recurrence within 100 days Hassan M. IDSA 2012 abs.1224

9. 2 of 2 Outcome of intestinal microbiota transplantation on death/colectomy in patients with severe/fulminant Clostridium difficile infection (CDI) • 28/28 (100%) tolerated the procedure well, no AEs • 28/28 (100%) recovered dramatically within 1-4 days post transplant • 28/28 (100%) had no recurrence within 100 days post transplant Intestinal microbiota transplantation for refractory severe/fulminant colitis due to CDI appears life-saving and safe Hassan M. IDSA 2012 abs.1224

10. 1 of 2 Risk factors associated with systemic absorption of oral vancomycin in the treatment of Clostridium difficile colitis (CDC) Retrospective single-centre study in 85 adult (≥18 yr) patients with CDC receiving oral vancomycin during ≥5 days without concomitant iv vancomycin Vancomycin serum levels during therapy assessed on day 5, 10 and weekly thereafter Multivariate logistic regression analysis to assess risk factors for systemic absorption of vancomycin with P value of ≤0.20 on Chi-square analysis Carver PL. IDSA 2012 abs.1637

11. 2 of 2 Risk factors associated with systemic absorption of oral vancomycin in the treatment of Clostridium difficile colitis (CDC) • 60 patients (71%) had ≥1 detectable vancomycin plasma level (range 0.05-9.94 µg/ml) of which 15 patients ≥1 level >2.5 µg/ml CDC severity, oral vancomycin dose, ICU admission and gastrointestinal pathology seem risk factors for systemic absorption Carver PL. IDSA 2012 abs.1637